Plantar fasciitis is a common condition that can be caused by one of a combination of factors including poor foot structure, and inappropriate shoes, trauma, overuse, prolonged inactivity (underuse), or improper loading. These can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes, resulting in heel pain.
The plantar is made of collagen, a rigid protein that’s not very stretchy, but acts as a dynamic stabilizing and neurologic responsive network as well. Amazingly, fascia is capable of stiffening or relaxing in response to the demand that we place on the joints and musculature. The stress of overuse, over-pronation, or a number of chain reaction restrictions in movement can rip tiny tears in fascia, causing heel pain and inflammation, referred to as plantar fasciitis.
Common symptoms of plantar fasciitis
Plantar fasciitis typically feel a sharp stab or deep ache in the middle of the heel or along the inside or medial arch of the foot. Another sign of plantar fasciitis is referred to as the “morning hobble” from the foot trying to heal itself in a contracted position overnight resulting in increased pain on first morning steps or after any prolonged non-weight bearing activity. Taking that first step causes sudden strain on the bottom of the foot, resulting in heel pain or pain in the arch. The pain can recur after long spells of sitting, but it tends to fade after repeated use, once the area is sufficiently warmed up.
Common causes of plantar fasciitis
The condition of plantar fasciitis can also be caused by biomechanical flaws, including flat, high arches, and a tight Achilles tendon (Achilles Tendonitis); excessive pronation; sudden increases in training mileage; seated work position (office or driving related); running; or possibly even a woman wearing high heels
Prevention and treatment of plantar fasciitis
For symptoms occurring longer than 3 weeks, a proper evaluation from a medical professional to rule out potential more serious pathologies (Stress-Fracture, Lumbar disc herniation, etc.) there are many treatments available for you-
Manual therapy, consisting of joint and soft tissue mobilization of the foot to increase mobility of the foot and increase calf flexibility is effective in treating individuals with heel pain/Plantar Fasciitis. In addition, manual therapy with a stretching program has been proven far more effective than stretching alone for Plantar Fasciitis.
Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, McDonough CM, Altman RD, Beattie P, Cornwall M, Davis I. Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy. 2014 Oct 31.
Renan-Ordine R, Alburquerque-SendÍn F, Rodrigues De Souza DP, Cleland JA, Fernández-de-las-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. Journal of orthopaedic & sports physical therapy. 2011 Feb;41(2):43-50.
Many home exercises and stretches are proven to be very beneficial in the treatment of both chronic and acute cases of plantar fasciitis. Proper assessment of both local and contributing systems need to be functioning properly including the ankle, hip and upper back. Utilizing the entire “chain” that contributes tension and force to the plantar fascia, can increase treatment effectiveness and limit recurrence of chronic strain on this important tissue
Rest, Ice, Compression and Elevation- This is the prevalent recommendation for all sprain/strain injuries- A plastic water bottle with at least a quarter of the contents removed and the remainder frozen in the freezer makes a great massage/ice tool-
Ice should only be performed for 20 minutes on then 60 minutes off. Repeat as necessary. Be careful not to burn your skin. A barrier between the ice and your skin is always recommended. Place a towel or keep a sock on to create a barrier between you and the water bottle.
Cold Laser Therapy – (Low Level Light Therapy)
Cold laser has been shown to decrease inflammation in both chronic and acute situations and has reduced healing time related to condition like plantar fasciitis. This technique can also be combined with both manual therapy and exercise/stretching to maximize benefits and treatment effectiveness.
Taping – Athletic tape (Low Dye) and Kinesiotaping
Taping the affected plantar fascia can help support the tissue while it heals and help you maintain activity, minimizing discomfort. This is typically used in the short term to aid in movement and allow for increasing activity.
Many other treatment options are available after conservative therapies have failed including injections, platelet-rich plasma injections, orthotics, and surgery. An evaluation with our chiropractor, primary doctor, or podiatrist can help find a treatment that is best suited for you.
Plantar Fasciitis in Runners
Plantar fasciitis can be a nagging problem, which gets worse and more difficult to treat the longer it’s present. To prevent plantar fasciitis, vary running surfaces including trail, road and track; keep mileage increases to less than 10 percent per week; and wear the proper shoes for your foot type and gait.