Plantar fasciitis is simply inflammation of the plantar fascia. It is the term commonly used to describe pain in the underside of the foot, mainly affecting the heel and can radiate along the arch. It occurs due to irritation of the plantar fascia, a thick band of connective tissue that runs along the bottom of the foot connecting the heel to the base of the toes. This band acts as a sort of spring to aid in propelling ourselves forwards and also supports the arch of the foot. This is called the Windlass mechanism and plantar fascia pain is caused by excessive load on this mechanism.
Plantar fasciitis occurs due to repetitive micro-tears at the insertion of the plantar fascia to the heel and the continuous healing process that occurs while trying to repair them. It affects a wide cross-section of the population but is most common in people between 40-60 years of age and who are overweight. Women tend to be affected more often than men.
Common risk factors
- Heel Spurs – small bone growth due to excessive loading of the plantar fascia
- Age (40-60 years)
- Low or high medial arch of the foot
- Achilles and calf tightness
Common Causes of pain:
- Increase in activity too quickly – getting back into running
- Sustained burst of activity out of the norm – long hike
- Prolonged standing or walking on hand ground
What do I feel?
- Pain in the heel, can radiate down into the arch
- Gradual increase in pain over time
- Can feel like having a stone in your shoe
- Pain in the morning with the first few steps, eases off somewhat with movement
- Pain following periods of rest, eases off somewhat with movement
- Pain pattern during activities such as walking or running:
- Sore to begin with, eases off slightly as you warm up, then builds up again with longer periods of activity
- Most sore after you stop and rest
What can I do?
- Activity modification – reduce aggravating or pain causing activity. Relative rest, not complete rest
- Self-massage bottom of the foot with golf ball or frozen drink bottle
- Stretch your calves and plantar fascia
- Review with a physiotherapist for an effective rehabilitation plan.
Symptom relief is important to allow you to continue with your daily activity. Engaging in an effective rehabilitation programme is important to reduce risk of recurrence and guide return to recreational activity.
Rehabilitation for plantar fasciitis involves:
- Strengthening of calves and gradual loading of plantar fascia
- Functional and biomechanical assessment and exercises as appropriate.
- Taping and insoles
- Pain guided return to activity.
- Other modalities such as shock wave therapy, massage, and acupuncture.
Pain in the plantar fascia region is best treated early. Modifying aggravating factors and getting an appropriate rehabilitation plan makes for a smoother recovery. These issues can persist and/or recur so having a management plan to go back to will help limit the effect of these recurrences.
This information is intended as a guide only. For specific information regarding injury assessment and management, you should always consult your health professional.