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Plantar fasciitis is a very common condition resulting in pain under the heel which often radiates into the foot. We explain the symptoms, treatment and specific exercises used to cure this common form on heel pain.
Plantar fasciitis symptoms consist of 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 which is initially 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 under the foot may be painful.
What is plantar fasciitis?
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 tendon fibres close to the attachment to the heel bone.
It is common in sports which involve running, dancing or jumping. Runners who overpronate where their feet roll in or flatten too much are particularly at risk the fascia under the foot is over stretched as the foot flattens.
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 repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength. Other causes include either a low arch called pes planus or a very high arched foot known as pes cavus.
Excessive walking in footwear which does not provide adequate arch support has been attributed. Footwear should be flat, lace-up and with good arch support and cushioning. Overweight individuals are more at risk of developing plantar fasciitis due to the excess weight impacting on the foot.
Plantar fasciitis treatment
Although there is no single cure, many treatments can be used to ease pain. In order to treat it effectively for the long-term, the cause of the condition must be corrected as well as treating the symptoms. Treatment for plantar fasciitis can be done by both athlete and professional.
What can the athlete do?
Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. A plantar fasciitis taping technique can help support the foot relieving pain and helping it rest.
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.
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.
A night splint is an excellent product which is worn overnight and gently stretches the calf muscles preventing it from tightening up overnight.
What can a Sports Injury Professional do?
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.
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.
Deep tissue sports massage techniques can reduce the tension in and stretch the plantar fascia and the calf muscles. Extracorporeal shock wave therapy has been known to be successful and a corticosteroid injection is also an option.
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 rehabilitation program for more details on treatment of planter fasciitis.