One of the more common injuries we see in the office, especially when dealing with the feet, is Plantar Fasciitis (PF) – a common and often persistent injury seen in runners, menopausal and pregnant women, and generally those who spend a lot of time on their feet.
The cause of PF is often unknown. It is usually associated with overuse during high-impact exercise and sports and accounts for up to 9% of all running injuries typically caused by poorly-fitting shoes, lack of calf flexibility, or an uneven stride that creates an abnormal and stressful impact on the foot. Because the condition often occurs in only one foot, some factors other than overuse are likely to be responsible. There are many theories as to how and why people develop PF, including high arches, low arches, over-pronation, tight calves, incorrect shoes, and excess weight. Often times there are many factors contributing to each case.
The Plantar fascia (seen above) is a thick band of fibrous tissue that runs from beneath the toes to a common insertion point at the heel. This insertion point is normally the area that becomes painful with repetitive stress, causing inflammation and degeneration of the connective tissue. Morning heel pain is the primary complaint associated with PF and at times can be debilitating, causing even the smallest task unbearable.
As the foot strikes the ground the fascia is used as both a shock absorber and spring mechanism for propulsion. During the walking or running gait, abnormalities in the biomechanics of the foot can cause increased stress on this area. For instance, an ankle that is too tight in certain areas of movement might compensate by becoming hypermobile in other parts causing pronation or arch collapse. We do know there is a direct correlation as to how tight the gastrocnemius/soleus/Achilles complex is, and how tight the plantar fascia is. The tighter the Achilles, the tighter the PF.
Sometimes PF can be hard to get rid of. We’ve seen many patients in the office for treatment after having suffered from it for years. If you’re in pain:
- Get it treated as soon as you can! The earlier you consult a professional, the less likely it is to hang around.
- Have good support. Wear shoes with support as much as possible and ensure you evaluate your running/walking shoes.
- Limit the morning pain. Have shoes or sandals by the bed…put them on before you put your feet on the floor. Do NOT walk around barefoot.
- Night Splints: Some evidence suggests that splints worn at night may be helpful for some people.
- Stretch. Stretching the plantar fascia and calf is the mainstay therapy for restoring strength and flexibility.
- A good functional orthotic. It doesn’t have to be custom made. These go in athletic shoes will help alleviate the pressure on the heel and PF. Brands we use include: Sole, Powerstep, and Superfeet.
The three major treatment goals for plantar fasciitis are:
- Reducing inflammation and pain
- Reducing pressure on the heel
- Restoring strength and flexibility
How PF is treated on our office:
- A biomechanical evaluation of the foot and lower extremity to determine cause of the problem.
- Active Release Technique to the foot and soft tissue of the lower extremities to reduce tension on the PF.
- Address any alignment issues that may be causing excess pressure on the PF.
- Taping techniques (seen below) provide extra support to the arch and alleviate pressure on the PF.
- Provide home-based rehab exercises that are extremely important to overcome PF issues.
Golf Ball Roll:
Rolling a golf ball on the arch of the foot for two-minutes each day can help reduce tightness. It’s important to stay away from rolling on the heel so as not to aggravate inflammation further. Roll the arch area only.
Calf/Achilles and Foot Stretches:
The New York Times recently published an article on PF stating that the below exercise is the mainstay for eliminating PF pain.