Plantar Fasciitis: What Is It and How Do I Fix It?
This article is neither meant to replace nor act as medical advice. It is merely presenting supplemental information to help you understand the safe return to play process. Please consult an athletic trainer or doctor for an individualized information and treatment program.
Plantar fasciitis can be caused by a multitude of different factors ranging from overuse to your natural biomechanics. A diagnosis is based mostly on patient history. Treatment options include massage, stretching, and icing.
As a certified athletic trainer, I am often asked about a variety of sports injuries. One of the most common is, "What is plantar fasciitis?" Simply put, it is inflammation of the plantar fascia tissue. This tissue is located on the bottom of your foot. Anyone who has experienced this can tell you exactly where it is.
I'm writing this article because of the amount of misinformation I see out there. Whether or not it is intentional I want to set the record straight on the cause and and treatment of this injury.
Foot Anatomy 101
What is the plantar fascia?
The plantar fascia is tissue that attaches at the calcaneus (heel bone) and runs to the heads of the metatarsals. For a better idea, see the picture under the heading Foot Anatomy 101.
Ok, What's Plantar Fasciitis?
Plantar fasciitis is the inflammation of the plantar fascia. This can be caused by a number of different thing including a single traumatic force, repeated stress, biomechanical deficits, heel spurs, nerve entrapment, and achilles tendon tightness.
Having pes planus (flat feet) or pes cavus (high arches) can increase your predisposition to plantar fasciitis.
Plantar fasciitis can occur after a significant change in activity intensity and duration, long periods of standing, training errors, or limited dorsiflexion (bringing your foot and toes up towards you) ankle range of motion.
When plantar fasciitis occurs with a patient who has pes planus or pes cavus, the cause is thought to be the biomechanics of the foot.
Plantar Fasciitis Pain
How is it Diagnosed?
The diagnosis is made primarily from the patient's history and physical examination. Usually, the pain is focused near the origin on the medial calcaneal tubercle (heel of the foot towards the inside). It is not uncommon for the fascia to be sore on the entire length.
A common symptom is pain when stepping out of bed in the morning or pain when walking after a long period of non-weight bearing (generally sitting).
X-rays do not provide any help with this diagnosis, unless the cause is a heel spur (uncommon). MRIs and Ultrasounds can help during the early stages of plantar fasciitis.
Plantar Fasciitis Treatments
Cool, How Do I Treat It?
Conservative treatment of plantar fasciitis is effective in about 80% of patients. Conservative treatments include wearing a night splint (picture below). Other treatments include anti-inflammatory medication, orthotics, heel cups, and stretching of the plantar fascia and lower leg muscles.
The combination of heel cups and stretching is five times more effective in treating plantar fasciitis than custom orthotics alone.
A fantastic way to stretch and massage the plantar fascia is by freezing a water bottle then rolling it on the bottom of your foot. This combines the benefits of icing and massaging at the same time. You can also use a tennis ball to massage the bottom of your foot. Another stretch you should incorporate is a calf stretch with both a straight and bent knee. Stretching with a straight knee stretches the gastrocnemius and the bent knee stretches the soleus (see calf stretch picture below). Both of these attache through the achilles tendon to the calcaneus.
People have been known to use a lacrosse ball or golf ball. These are much firmer and smaller and can cause more discomfort than help when first starting out.
The taping option is an easy, cheap way to see if the relatively more expensive brace will be of benefit to you. See the video below. It is unnecessary to use the spray on adhesive like the video shows.
The two braces shown to the right are two of the multiple options you have to choose from. These are the basic examples. You can find many different brands at your local sporting goods store, running store, or online.
So It's Not Getting Better, What Now?
The next step you be to see your physician and ask for a prescription for physical therapy. At physical therapy they can offer services like ultrasound or iontophoresis to help with healing.
If physical therapy does not work then the doctor might try a corticosteroid injection into the plantar fascia.
If it is at all possible I would try to get an appointment with a sports medicine physician. While your regular physician is very knowledgeable about many different things, a sports medicine physician has a deeper understanding of these orthopedic conditions.
Low Dye Arch Taping
This has been a brief anatomy lesson and overview of plantar fasciitis treatments. There are many charlatans that claim to have a miracle cure that works in a day. There is not a quick, one day fix. This article is based on solid, scientific, documented evidence. So, performing these stretches and using a brace will help to cure plantar fasciitis.
Have you suffered from plantar fasciitis?
Starkey, C., Brown, S. D., & Ryan, J. L. (2010). Examination of orthopedic and athletic injuries (Ed. 3. ed.). Philadelphia: F.A. Davis Co.
© 2014 Trainer Joe