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Pain Profile: Plantar Fasciitis
Plantar fasciitis is the most common hindfoot problem in runners affecting about 10% of the running population (Anderson and Parr, 2009, p.672). Whether you like to run long distances, high intensity intervals, or something in between, plantar fasciitis can stop you from continuing to improve your fitness.
Anatomy
Tarsals – a group of bones made up of the calcaneus (heel), talus, navicular, cuboid, lateral cuniform, medial cuniform, and middle cuniform (foot bones). The tarsals are located in the posterior (back) of the foot and serve as attachment points for muscles, ligaments, and fascia (Anderson and Parr, 2009, p.640).
Metatarsals – a group of five bones located between the tarsals and the phalanges (toes) (Anderson and Parr, 2009, p.640).
Longitudinal Arch – a supportive structure to distribute body weight throughout the foot. The longitudinal arch runs from the calcaneus (heel) to the metatarsal heads (ball of the foot) and occurs on both the medial (inside) and lateral (outside) portions of the foot. The medial longitudinal arch is higher off the ground than the lateral longitudinal arch (Anderson and Parr, 2009, p.644).
Transverse Arch – another supportive structure to distribute bodyweight throughout the foot. The transverse arch runs across the anterior tarsals and metarsals (Anderson and Parr, 2009, p.644.)
Plantar Fascia – also called the plantar aponeurosis, the plantar fascia is an interconnected, specialized, and thick band of connective tissue that covers the plantar surface (bottom) of the foot to support the longitudinal arch. The plantar fascia acts like a spring to push the foot off the ground while walking and running. The plantar fascia can stretch 9-12% of its resting length during walking and running (Anderson and Parr, 2009, p.644-646.)
Plantar fasciitis occurs when the plantar fascia becomes overused and overloaded. An overload on the plantar fascia occurs when a training error occurs like doing too much too soon, not allowing adequate rest between training sessions, or improper periodization. Improperly fitting shoes, performing activities on unyielding surfaces like concrete or rocky surfaces, pes planus (flat feet), pes cavus (high arches), a tight Achilles tendon, and excessive pronation of the foot can also contribute to plantar fasciitis.
Signs and Symptoms
Some of the signs and symptoms of plantar fasciitis are sharp pains on the plantar surface (bottom) of the foot and medial (inside) of the heel with activity or weight bearing. In some cases of plantar fasciitis the pain may be relieved temporarily with certain activities but after cessation of the activity the pain returns. The pain may be the worst in the morning just after waking and within the first 10-20 minutes of waking. Pain may also radiate into the lateral (outside) foot. Muscle spasms in the foot and calf are common as well. The plantar surface of the foot will be tender when touching or massaging. Pain will increase if the toes are pulled into extension (pulling towards the shin) while the ankle is dorsiflexed (foot is flexed) (Anderson and Parr, 2009, p.644-672.).
General Treatment
As with any inflamed area, the patient should use the RICE method. Rest the foot as much as possible and avoid any painful activities. Ice the area at least once a day after activities that are difficult or painful. Ice the knee for 20 minutes at a time with at least 60 minutes between icing sessions. If the patient is functional enough to perform physical activity without pain, do not ice before activity. Save the ice until after the activity is over. Another method of icing for plantar fasciitis is to freeze a plastic water bottle and roll the bottle under the foot to combine ice and massage. Rolling the frozen water bottle under the foot for 5 minutes at a time several times a day will help keep the fascia from accumulating new inflammation. Compress the joint with snug socks to help keep the area supported. There are specially designed socks that will compress the foot. Wearing compressive socks can be a helpful adjunct to other treatment but will not fix the problem on its own. Elevate the joint to help relieve pressure on the joint and to reduce swelling. When elevating the foot, it should be above the level of the heart so any excess fluid will be pulled back into circulation.
Lengthening and stretching the plantar fascia will also help reduce pain. The patient can use a firm ball like a golf ball or baseball to roll under the foot to massage the tissue. Rolling a ball under the foot can provide immediate relief and is helpful to do as a maintenance treatment after the initial pain has subsided.
The plantar fascia can also be stretched by doing toe and calf stretches. Putting the toes on a wall while keeping the heel flat will help stretch the distal portion of the plantar fascia. A standard calf stretch with the heel flat on the ground and moving the body forward will help stretch out the proximal portion of the plantar fascia. Foam rolling the calf and Achilles will also help relieve tension on the plantar fascia as well.
Another way to reduce the load on the plantar fascia is to ensure that the proper footwear is worn. A store that specializes in running shoes should be able to fit the proper type of shoe to your foot. In my experience, the sales associates at large chain sporting goods stores do not fit shoes properly. A store that sells only running shoes will give you a better chance of getting the right type of shoe for your foot. Avoid minimalist type shoes if you are getting plantar fascia pain. Arch supports can also be inserted into existing footwear to help support the foot as well.
Altering your running gait can also reduce the amount of stress on the plantar fascia. Entire books have been written about running form and I will try to keep the recommendations in this article brief and concise. If your heel hits the ground first while running, this can cause a lot of stress on your foot, ankles, knees, hips, and back. Landing on the midfoot makes your body act more like a spring to absorb the impact of running and the impact will be dissipated over more tissue in a longer period of time. It has taken me years to find a running gait that works well for me so don’t get too frustrated with implementing too many changes to your running form all at once. Small changes over the course of several weeks will also give your body time to adapt to the new running gait.
Conclusion
Plantar fasciitis is a common injury that can be managed with several different types of treatment. Many at home treatments can help manage the signs and symptoms of plantar fasciitis but if you have experienced worsening symptoms or symptoms that are not relieved by the aforementioned suggestions, then a visit to your primary care doctor is warranted.
Reference
Anderson, M., & Parr, G. (2009). Shoulder Conditions. In Foundations of athletic training: Prevention, assessment, and management (4th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Note: This article is intended purely for educational purposes. It is not intended to diagnose, treat, or replace advice from a qualified healthcare professional. Every person with an injury is different and needs an evaluation by a physician, physical therapist, athletic trainer, or qualified healthcare professional to identify any problems. Please consult a qualified healthcare professional if you are experiencing any of the signs and/or symptoms described.