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Plantar fasciitis is probably the most common cause of heel pain which often radiates into the arch of the foot. We outline the symptoms and explain treatment, rehabiltiation exercises, taping and more.
- A gradual onset of pain under the heel which may radiate into the foot.
- Tenderness is usually felt under and on the inside of the heel.
- Pain is usually worse first in the morning but eases as the foot warms up only to return later in the day or after exercise.
- Stretching the plantar fascia may be painful.
The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. Through overuse the fascia can become inflamed and painful at its attachment to the heel bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is thought to be degeneration of the collagen fibres close to the attachment to the heel bone.
Plantar fasciitis is an overuse injury. Repetitive over-stretching of the plantar fascia under the foot leads to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength. This is common in sports which involve running, dancing or jumping. The following can increase the likelihood of developing it:
- Overpronation - Runners who overpronate where their feet roll in or flatten too much are at risk because the plantar fascia is over stretched as the foot flattens.
- High arched foot - People with pes cavus or a high arch in the foot are at risk because the foot is unable to absorb shock and adapt to the surface.
- Tight calf muscles - A common factor is tight calf muscles which lead to a prolonged or high velocity pronation or rolling in of the foot. This in turn produces Other causes include either a low arch called pes planus or a very high arched foot known as pes cavus.
- Poor footwear - Excessive walking in footwear which does not provide adequate arch support has been attributed. Footwear for plantar fasciitis should be flat, lace-up and with good arch support and cushioning.
- Overweight - Overweight individuals are more at risk of developing plantar fasciitis due to the excess weight impacting on the foot.
- Previous injury - if you have suffered a plantar fascia strain or injured the underneath of your foot which fails to heal properly then this can lead on to plantar fasciitis.
Treatment of plantar fasciitis
Although there is no single cure, many treatments can be used to ease pain. Options usually fall in one of two categories; short term and long term. In order to treat it effectively for the long-term, the cause of the condition must be corrected as well as treating the symptoms.
Rest & Ice
Rest until it is not painful. It is difficult to rest the foot so if you have to be on your feet wear comfortable training shoes or use the taping technique explained below. A gel type cushioning heel pad may help with symptoms. Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied for 10 minutes every hour if the injury is particularly painful for the first 24 to 48 hours. This can be reduced to 3 times a day as symptoms ease.
A plantar fasciitis taping technique can help support the foot relieving pain and helping it rest. A simple roll of 2.5cm or 1 inch non stretch zinc oxide sports tape can be applied in a number of ways which all basically take the strain off the plantar fascia relieving pain and allowing it to heal. We demonstrate two simple methods of taping the foot to relieve symptoms:
See more on taping.
The plantar fasciitis night splint can be a very effective way of treating the condition. The reason the foot is so painful in the morning is because the fascia tightens up over night. As you get warmed up from walking on the foot the pain reduces. The night splint works by helping to prevent the fascia tightening up and so relieving pain.
Play night splint video
Specific exercises can be done if pain allows, in particular stretching the fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The fascia tightens up making the origin at the heel more susceptible to stress. Later on strengthening exercises may be done to help prevent the injury recurring but stretching is the priority initially.
See more on exercises.
A doctor may prescribe anti-inflammatory medication such as ibuprofen to help reduce pain and inflammation.
Electrotherapy such as ultrasound or laser may also help with symptoms. Ultrasound passes high frequency sound waves deep into the tissues to provide a micro massage effect. Laser sends a high intensity beam of light similarly into the painful areas. Extracorporeal shock wave therapy has been known to be successful.
Deep tissue sports massage techniques can reduce the tension in and stretch the plantar fascia and the calf muscles. Self massage can also be applied by rolling a frozen can or hard rubber ball under the arch of the foot.
An Ultrasound scan is usually recommended to identify and measure a thickening of the fascia. An X-ray may be taken to see if there is any bone growth or calcification, known as a heel spur but this is not necessarily a cause of pain.
A corticosteroid injection may be given in conjunction with other forms of treatment although some may be concerned with an increased risk of rupture and wasting away of the cushioning fat pad under the heel.
An important part of prevention is to perform a gait analysis to determine any biomechanical problems with the foot which may be causing the injury. This can be corrected with orthotic inserts into the shoes.
If symptoms do not resolve then surgery is an option, however this is more common for patients with a rigid high arch where the plantar fascia has shortened.
See plantar fasciitis rehabilitation program for more details on treatment of planter fasciitis.