December 2019 newsletter.
Sources: American Academy of Orthopaedic Surgeons & Runner’s World Magazine. Images: American Academy of Orthopaedic Surgeons.
The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot. Plantar fasciitis is the most common cause of pain on the bottom of the heel. It occurs when this strong band of tissue becomes irritated and inflamed.
Causes. Plantar fasciitis can be caused by biomechanical flaws, including flat, high-arched feet and tight calves muscles; excessive pronation and being overweight. In some cases, plantar fasciitis can develop without a specific, identifiable reason. Especially for runners, sudden increases in training mileage; beginning speed or hill work; wearing worn or inappropriate running shoes; running on hard surfaces, like asphalt or concrete; or wearing high heels all day before switching into flat running shoes can overload the plantar fascia and lead to plantar fasciitis.
Symptoms. Plantar fasciitis sufferers feel a sharp stab or deep ache in the middle of the heel or along the arch. Another sign is the morning hobble from the foot trying to heal itself in a contracted position overnight. Taking that first step causes sudden strain on the bottom of the foot. The pain can recur after long spells of sitting, but it tends to fade during a run, once the area is warmed up.
Prevention and treatment of plantar fasciitis. Plantar fasciitis can be a nagging problem, which gets worse and more difficult to treat the longer it’s present. To prevent plantar fasciitis, run on soft surfaces, keep mileage increases to less than 10 percent per week, and visit a specialty running shop to make sure you’re wearing the proper shoes for your foot type and gait. It’s also important to stretch the plantar fascia and calves muscles.
At the first sign of soreness, massage (roll a golf ball under your foot) and apply ice (roll a frozen bottle of water under your foot, 3 to 4 times a day). What you wear on your feet when you’re not running makes a difference. Arch support is key, and walking around barefoot or in flimsy shoes can delay recovery.
Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. Crosstraining (doing other sports, where your feet don’t pound on hard surfaces) is a good way to stay fit during your recovery.
Stretchings. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Ask your health care provider how to stretch these structures.
Ultrasound therapy. Ultrasounds are helpful in reducing inflammation, increasing plantar fascia extensibility and in speeding the healing process.
Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or custom orthotics reduces this tension and the microtrauma that occurs with every step. Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep and is sometimes necessary to treat this condition.
Cortisone injections and surgery. Cortisone is a powerful anti-inflammatory medication that can be injected into the plantar fascia to reduce inflammation and pain. However, it should be seen as a last resort solution, because multiple steroid injections can cause the plantar fascia to rupture (tear). Surgery gives usually good results. However, because it can result in chronic pain and complications, it is recommended only after all nonsurgical measures have been exhausted.