Plantar Faciitis is a persistent pain located on the plantar (bottom) of the heel and the medial (inside) of the foot. The plantar fascia is a fibrous, tendon-like structure that extends the entire length of the bottom of the foot, beginning at the heel bone and extending to the base of the toes. During excessive activity the plantar fascia can become irritated, inflamed and may even tear if the area is subjected to repetitive stress. Heel contact during the gait cycle exposes a specific area to this stress. This area is known as the medial-plantar aspect of the heel, where the plantar fascia attaches to the heel bone.
The pain resulting from this injury is most noticable in the morning when the first few steps are taken and subsides with prolonged walking. Likewise, during athletic activity the pain will occur in the beginning of the exercise routing and subsides as activity continues.
Causes of Injury
Plantar Fasciitis is more common in athletes who have a high-arch, rigid type of foot or a flat, pronated foot. In motion, the plantar fascia experiences continuous stress and excessive pulling which results in inflammation and pain.
- A high-arch foot has a tight band-like plantar fascia that is rigid during the gait cycle.
- The plantar fascia is stretched in the pronated foot by excessive motion
- Improper shoe selection can be a cause of the injury; foot and gait type must be considered.
- Stiff-soled shoes can cause stretching of the plantar fascia.
- Overworn shoes allow the foot to pronate more extensively and can result in an injury to the plantar fascia.
- The most common cause is a sudden increase in the amount or insensity of activity within a short period of time.
Short Term Treatment
In determining the proper treatment for Plantar Fasciitis it is important that the athlete knows and eliminates the causative factors of the injury. A complete medical history analysis, pedal examination, gait analysis and x-rays to check for a heel spur are recommended.
Ice application and strapping.
Complete rest or a reduction in the intensity of exercise.
Physical therapy involving whirlpool and ultrasound.
Anti-inflammatory medication, such as pills or cortisone injections, to alleviate severe pain in acute cases.
Long Term Treatment
In cases that are persistant, orthotic devices help correct biomechanical problems and alleviate stress and strain on the planta fascia.
High arches require softer orthotic devices for shock absorbtion.
Flattened arches require a more rigid orthotic to control pronation.
To prevent recurrence, planta fascia and calf muscle stretching exercises.
Many patients respond to these forms of treatment; only a very small percentage of patients require surgery.