With all of the runners, joggers, soccer, and football players in the
Bay Area, we've been seeing a lot of Plantar Fasciitis. Plantar
fasciitis is the most common overuse injury causing foot pain in
middle aged to older adults. Affecting the sole of the foot, it often
causes heel pain, but sometimes pain is also felt on the middle or
outside of the foot.
The plantar fascia is a multi-layered band of fiber that runs along the
sole of the foot from the heel bone to the toes. Plantar fasciitis is a
painful irritation of the plantar fascia.
What are the Symptoms of Plantar Fasciitis?
Foot pain: Usually heel pain in the middle or on the inside of
the heel, but can affect the middle of the sole of the foot as well.
Gradual onset: The foot pain comes on gradually over time, there
usually won't be one incident that can be identified as having caused
Pain is the worst for the first few steps each morning or the first few steps after sitting for a prolonged period.
What Causes Plantar Fasciitis?
It is thought that plantar fasciitis is a result of repeated
micro-tears in the tissue that occur over a prolonged period of time
eventually setting up a chronic inflammation and associated pain.
Why me?- What Makes it More Likely that you will get Plantar Fasciitis
Excessive pronation. On every step the foot hits the floor
towards the outside border of the heel, as weight is transferred onto
the foot it flattens to the floor, then rolls over to the inside of the
foot ready to push off through the big toe to push you forwards. People
who overpronate roll further onto the inside of the foot; this increases
the stress on the plantar fascia
Spending lots of time stood on tip toes, for instance wearing high heels.
Tightness in the achilles tendon. Attachment of the plantar
fascia means that tightness in the achilles tendon adds tension to the
plantar fascia. Tightness in the achilles tendon also contributes to
overpronation of the foot.
Obesity or rapid weight gain, for instance during pregnancy, increases the strain on the plantar fascia
Weak peronei. These are the muscles that control the upwards and
outwards movement of the foot. Weakness in them leads the foot to
flatten more quickly and with less control on each step increasing the
tension on the plantar fascia.
Underlying rheumatoid arthritis or ankylosing spondylitis
increases the likelihood of getting plantar fasciitis. If you have
plantar fasciitis in both feet it is worth having some blood tests to
eliminate these and other rheumatic diseases as the underlying cause for
the plantar fasciitis.
What's the treatment for Plantar Fasciitis?
Stretching exercises- often the plantar fascia and the Achilles tendon require stretching
Strengthening exercises including ones for the peronei and
muscles higher up the leg to control its rotation. We can provide an
exercise program tailored to treat your foot pain
Reduce the chronic inflammation - ice or a contrast of ice and
heat can be helpful. Try filling an empty plastic bottle with water,
freeze it. Place a damp wash cloth over it to prevent yourself from
getting a freezer burn then roll it backwards and forwards under your
foot. A corticosteroid injection can be considered, but with caution, as
a known risk of these is rupture of the plantar fascia.
Correct any underlying mechanical problems - for instance any overpronation at the foot
Taping- this can be useful to take the pressure off the plantar fascia and give it time to heal
Night splint - the first few steps each morning can often be the
most painful of the day. At night the foot rests in a relaxed position
with the toes pointing downwards, in this position the plantar fascia is
shortened. The theory is that healing occurs overnight, when the foot
is put to the floor in the morning the plantar fascia is stretched out
and the new healing tears. A night splint holds the foot with the ankle
at about 90 degrees so the fascia is not in a shortened position
Shock absorbing insoles, reduce the force transmission through each footfall.
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