Plantar fasciitis is one of the most common causes of heel pain. The pain is generally felt just in front of the heel bone and also on the inside arch of the foot. Plantar fasciitis is worse after prolonged periods of inactivity such as the first few steps in the morning or after sitting at a desk. This post will discuss what causes plantar fasciitis and what can be done about it.
The plantar fascia is a band of dense connective tissue that connects your toes to your heel bone on the bottom of your foot. The plantar fascia extends up to the calf muscles through the Achilles tendon, which helps form the posterior fascial sling. The plantar fascia aids in supporting the inside arch of the foot and transmitting force between the calf and the foot.
Plantar fasciitis is the term used to describe when there is pain on the bottom of the foot, specifically on the inside portion of the heel and into the inside arch of the foot. The term “fasciitis” is a little misleading in the cause of heel pain because it implies that the cause is inflammation.
Plantar fasciitis is actually an overload syndrome and seems to respond more like a tendinopathy. As an overload syndrome, the amount of force placed on the plantar fascia has exceeded its ability to tolerate it. Overloading of the plantar fascia can occur in a few different ways. The intensity, frequency, or duration of an activity can increase the force placed on the plantar fascia leading to pain. For example, a runner could have increased the how many times they run per week leading to overloading of the plantar fascia. Or a waiter could have picked up a few more shifts causing him or her to stand on their feet long, an example of increasing duration. Plantar fasciitis is also common in pregnancy, possibly due to the sudden increase in weight, an example of increasing intensity of force on the foot.
Heel spurs were once believed to be the cause of heel pain. While in some cases this may be true, there appears to be a high rate of heel spurs found in those without heel pain. The presence of a heel spur may be more of an indication of the amount of force that is being placed on the plantar fascia.
There are a couple things that you can do to help decrease the pain of plantar fasciitis.
The first thing to do is manage the load being placed on the plantar fascia. Since plantar fasciitis is considered an overload syndrome, decreasing the load placed on the tissue will help decrease the pain. This may mean temporarily limiting the amount of running or standing so that the plantar fascia can calm down.
Self myofascial release using a lacrosse ball or a golf ball can also help decrease the sensitivity of the plantar fascia. This is especially useful to do after a long period of inactivity, such as before getting out of bed or getting up from working at a desk. You would take a lacrosse ball or golf ball and slowly roll along the bottom side of the foot for between 30-60 seconds.
Once the plantar fascia beings to decrease, a progressive loading program can start for the plantar fascia. An example of a loading program for the plantar fascia could be starting with towel crunches then progressing to heel lifts. The program would then progress towards plyometric exercises, such as jumping or skipping.
Many plantar fasciitis cases require treatment to break the pain cycle. Treatment for plantar fasciitis typically includes manual therapy (either by hand or instrument), joint mobilizations, and kinesiology taping. These therapies help decrease the sensitivity of the plantar fascia so that a loading program can be better tolerated.