Plantar Fasciitis

The Injury

Plantar fasciitis (heel spur syndrome) is a common problem among people who are active in sports, particularly runners. It starts as a dull intermittent pain in the heel which may progress to a sharp persistent pain. Classically, it is worse in the morning with the first few steps, after sitting, after standing or walking, and at the beginning of a sporting activity. The plantar fascia is a thick fibrous material on the bottom of the foot. It is attached to the heel bone (calcaneus), fans forward toward the toes, and acts like a bowstring to maintain the arch of the foot. A problem may occur when part of this inflexible fascia is repeatedly placed under tension, as in running. Tension causes an overload that produces an inflammation usually at the point where the fascia is attached to the heel bone. The result is pain. Plantar fascia injury may also occur at midsole or near the toes. It is often most painful when taking the first few steps in the morning. Since it is difficult to rest the foot, the problem gradually becomes worse because each step continues to aggravate the foot. The inflammatory reaction at the heel bone may produce spike-like projections of new bone called heel spurs. They sometimes show on x-rays. They do not cause the initial problem - they are a result of the problem.

Contributing Factors

• Flat (pronated) feet
• High arched feet
• Sudden increase in activity
• Age
• Poor shoes

Treatment

Improvement may take longer than expected, especially if the condition has existed for a long time. During recovery, good shoes and sedentary activity will help the injury to heal. Return to full activity should be gradual.

• Rest: Use pain as your guide. If your foot is too painful, rest it.
• Ice: Apply ice to the bottom of the foot for 20-30 minutes several times daily. The ice will help reduce inflammation. Apply a plastic bag of ice over a towel. You should also ice the sore area for 15 minutes after activity.
• Medication: If your condition developed recently, anti-inflammatory medication may be all that is necessary to relieve pain and reduce inflammation.
• Physical Therapy: The initial objective of physical therapy is to decrease the inflammation. Later, the muscles of the foot can be strengthened to help support the arch of the foot.
• Shoes: Poorly fitting shoes can cause plantar fasciitis. The best type of shoe to wear is a good running shoe with excellent support.
• Orthotics: Foot orthotics are custom designed shoe inserts. A complete foot evaluation must be done and the orthotics are then fabricated by a physical therapist.