Plantar Fasciitis (pronounced “Plan-tar fash-ee-EYE-tis”) is the most common over-use injury to the foot. Considered a chronic inflammatory syndrome rather than a post-traumatic disorder, it is felt by most as heel pain that often is worst upon getting out of bed in the morning. This pain is otfen acute first thing in the morning or after a long rest because the fascia has contracted back while the person has been on his or her feet. As the day progresses, and the foot adapts, the plantar fascia gets stretched and the pain usually subsides.
1. Understanding Plantar Fasciitis
Plantar fasciitis, which may cause the heel to hurt, feel hot or swell, is inflammation of the plantar fascia, a thin layer of tough tissue supporting the arch of the foot. The Plantar Fascia runs from the heel bone to the base of the toes. Repeated microscopic tears of the plantar fascia cause pain. Sometimes plantar fasciitis is called “heel spurs,” but this is not always accurate, since bony growths on the heel may or may not be a factor. The heel spurs themselves are not the cause of pain but the chronic inflammation of the fascia is.
Diagnostic testing, such as X-rays, usually is not necessary to diagnose plantar fasciitis, although it may be useful to rule out other potential causes of heel pain. Typically with plantar fasciitis, the pain is worse when first getting out of bed, or is noticeable at the beginning of an activity and gets better as the body warms up. Prolonged standing may cause pain, as well. In more severe cases, the pain may worsen toward the end of the day.
There are a number of possible causes for plantar fasciitis and they often work in combination. Tightness of the foot and calf, improper athletic training, stress on the arch or weaknesses of the foot are potential causes. Shoes that don’t fit, certain play or work actions or overuse (running too fast, too far, too soon) may hurt the plantar fascia. People with low arches, flat feet or high arches are at increased risk of developing plantar fasciitis. While many traditions have been passed down to the present, more important was the service bestowed upon people that first day of business. Charlie and Dan held the belief that in their store, you are always a guest before you are a customer. This ideological foundation was built upon to create a powerful mission of service and 90 years later has proven unbreakable.
2. Who gets Plantar Fasciitis?
Plantar Fasciitis is common in runners and dancers who use repetitive, maximal plantar flexion of the ankle and dorsiflexion of the metatarsophalageal joints. For the non-athletes, one of the leading causes is overpronation or flat feet. This excessive arch collapse upon weight bearing stretches the plantar fascia, which can cause the inflammation. Plantar Fasciitis also is common in those who experience sudden weight gain and in overweight individuals who increase their activity level.
3. Treatment of Plantar Fasciitis
Symptoms usually resolve more quickly when the time between the onset of symptoms and the beginning of treatment is as short as possible. If treatment is delayed, the complete resolution of symptoms may take 6-18 months or more. Treatment will typically begin by correcting training errors, which usually requires some degree of rest, the use of ice after activities, and an evaluation of the patient’s shoes and activities. For pain, nonsteroidal anti-inflammatory drugs (e.g. aspirin, ibuprofen, etc.) may be recommended.
Next, risk factors related to how the patient’s foot is formed and how it moves are corrected with a stretching and strengthening program, coupled with proper footwear that cushions the heel yet supports the rest of the foot. If there is still no improvement, night splints (which immobilize the ankle during sleep) and orthotics (customized shoe inserts) are considered. Cortisone injections are usually one of the treatments of last resort, followed by surgery.
Using an ice pack or ice bath on the area for about 15 minutes may relieve pain and inflammation after exercise and work. Massaging the foot in the area of the arch and heel before getting out of bed may help. Stretching is also important.
4. Stretching Can Help
Some people feel that strengthening programs are the most helpful treatment and stretching is commonly prescribed by doctors. Stretching helps to speed recovery but is also useful to help reduce the chance of relapse. As always, people should get advice from a medical professional before starting any exercise program, but here are common stretching routines often recommended for those with plantar fasciitis.
Common stretches include the gastrocnemius muscle stretch. This is done by placing the heel of the back leg on the floor and stretching forwards. Hold for ten seconds, repeat three to five times and repeat the set three times a day. Gradually hold the stretch for longer (up to 45 seconds). You can also stretch the plantar fascia by rolling it over a round cylinder such as a bar or rolling pin. Sometimes a can works well, too. Roll the foot repeatedly over the bar or can applying downwards pressure. This non-weight bearing stretch is usually very helpful. A third stretch involves slinging a belt or towel across your forefoot and press and stretch into it. Hold for 30 seconds and repeat 5 times, perhaps three times a day.
5. The Role of Footwear
Wearing shoes that are too small may cause plantar fasciitis. Shoes with thicker, well-cushioned midsoles may help alleviate the problem. Running shoes should be frequently replaced as they lose their shock absorption capabilities. Studies have shown that taping the arch, or using over t-the counter arch supports or customized orthotics also help in some cases of plantar fasciitis. Custom orthotics are the most expensive option as a plaster cast is made of the individual’s feet to correct specific biomechanical factors. However, there are many lower-cost, over-the counter orthotic options available as well.
In general, the goal is to minimize foot movement so that the foot has the opportunity to heel. However, cushion is very important so shock doesn’t radiate into the foot. Having a soft and squishy shoe may “feel” good, but also can promote foot movement and rotation, which can delay healing.
So, when selecting shoes, look for shoes that have a firm heel counter (to deter foot movement) and a fairly firm sole (the shoe shouldn’t twist easily in your hands). However, there needs to be superior cushioning under the heel. For many, a running shoe or walking shoe may be fine, although an arch support or orthotic may be needed to keep the foot from over-flexing. A heel cup or heel cushion may be needed as well.
If heels need to be worn, try not to exceed 1” in height. Heels of any type, even dress shoes for men, may not be advisable as they provide limited support in the mid-foot.
6. Orthotics and Supports
Many doctors may suggest a custom orthotic as part of the treatment. The role of a custom orthotic is to support the feet, cup the heel and prevent excessive movement. Some customers may self-treat themselves by purchasing soft gel products. That may be helpful for some, but an overly soft insole may allow too much foot movement. Over-the-counter insoles or orthotics may be very helpful if they are designed to support the arch yet cushion the heel
Remember, when fitting over-the-counter supports, the arch needs to fit the foot properly. A support that doesn’t support the arch in the right place may do little to reduce foot movement. Many doctors recommend gel heel cups. These units help absorb shock while keeping more of the foot’s natural fat under the heel bone.
Insoles and supports are best placed inside the shoe with the footwear’s factory insole removed. This is for two reasons – first, placing a contoured insole on top of an already contoured insole may be less than ideally balanced. Second, a support placed on top of the shoes original liner may make a fit that is too shallow and tight for the foot.