By Dr. John A. Papa, DC, FCCPOR(C)
Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes. This condition is a common source of heel pain that can be quite disabling.
Plantar fasciitis usually develops gradually, but it can also come on suddenly. Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic. Pain and discomfort can also extend into the arch of the foot. Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity. If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.
Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot. Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed. This may occur with activities that require running, jumping or prolonged walking and standing. Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.
Faulty foot mechanics may also contribute to the development of plantar fasciitis. Individuals who excessively pronate (role feet inward) or are flat-footed will experience extra mechanical strain on their plantar fascia. Old lower extremity injuries such as ankle sprains and fractures increase risk due to altered lower limb movements. Heel and arch pain tends to be more common in middle and older aged people. With aging, the arch of the foot begins to sag, putting stress on the plantar fascia. Being overweight is also a risk factor. Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.
Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia. Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.
Plantar fasciitis that does not respond to self-care strategies may require professional treatment. This can include electrotherapy, manual and soft tissue therapy, and specific rehabilitative exercises. A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.
It is important to establish an accurate diagnosis of plantar fasciitis. Other causes of heel pain may include stress fractures, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation. If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance. For more information, visit www.nhwc.ca.
This article is a basic summary for educational purposes only. It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.