Cases of plantar fasciitis can linger for months at a time, with pain increasing and decreasing in an unpredictable pattern. Often, plantar fasciitis discomfort may nearly disappear for several weeks, only to re-emerge full-blown after a single workout. About 10 per cent of individuals who see a doctor for plantar fasciitis have the problem for more than a year.
The plantar fascia is actually a thick, fibrous band of connective tissue which originates at the heel bone and runs along the bottom of the foot in a fan-like manner, attaching to the base of each of the toes. A rather tough, resilient structure, the plantar fascia takes on a number of critical functions during running and walking. It stabilizes the metatarsal joints (the joints associated with the long bones of the foot) during impact with the ground, acts as a shock absorber for the entire leg, and helps to lift the longitudinal arch of the foot to prepare it for the 'take-off' phase of the gait cycle.
Although the fascia is invested with countless sturdy 'cables' of connective tissue called collagen fibres, it is certainly not immune to injury. In fact, about 5 to 10 per cent of all running injuries are inflammations of the fascia, an incidence rate which in the United States would produce about a million cases of plantar fasciitis per year, just among runners and joggers. Basketball players, tennis players, volleyballers, step-aerobics participants, and dancers are also prone to plantar problems, as are non-athletic people who spend a lot of time on their feet or suddenly become active after a long period of lethargy.
A recent study found that over 50 per cent of people who suffer from plantar fasciitis are on their feet nearly all day, and many cases of plantar fasciitis seem to occur in 'sofa spuds' shortly after they've made their first trip around their garden with a lawn mower in the spring.
Although it is a fairly rugged structure, the plantar fascia is not very receptive to stretching, and yet stretching occurs in the fascia nearly every time the foot hits the ground. Studies indicate that the fascia can unkink itself to no more than 102 per cent of its normal length without suffering at least some tearing, but the force equal to almost three times body weight which passes through the foot with each step forces the fascia to come close to this 'red zone of tautness' 90 times per foot per minute during the act of running ('Anatomy and Biomechanics of the Hindfoot,' Clinical Orthopaedics, vol. 177, pp. 9-15, 1983).
So, it's not surprising that plantar fasciitis occurs fairly frequently, nor is it a surprise that the damage - and pain - often tend to occur near the heel, where stress on the connective tissue fibres is greatest, and where the fascia itself is the thinnest (it tends to broaden out as it reaches toward the toes).
The heel locus for trouble is one reason why plantar fasciitis is often associated with 'heel spurs'. Those 'spurs' are simply wads of calcium deposited at the site where the fascia suffers most damage. The heel agitations also explain why the clinical manifestation of plantar fasciitis is usually strong discomfort at the bottom of the heel bone. More specifically, the person suffering from plantar fasciitis will often feel a pinpoint, knife-like pain at the 'medial tubercle' of the calcaneus (heel bone), which happens to be the exact location of the origin of the inside part of the plantar fascia. Swelling may occur just in front of the heel bone, and pain can radiate along the whole longitudinal arch of the foot.
Research shows that plantar fasciitis pain and heel problems are often associated with a number of causes. Here are the mosr common:
Changes in activity: a sudden increase in the volume or intensity of training or a simple increase in the total time you spend on your feet can cause plantar fasciitis. If you are starting a running or training program be careful to increase the volume of your training gradually - usually by a maximum of 10% per week.
Poor footwear: using worn-out shoes, especially while running on pavement or hard ground, will increase your risk. Don't run or train in shoes that are more than 12 months old, as over time any shoes will lose their cushioning ability. More impact on your feet from wearing old and tired shoes will cause plantar fascia problems.
Poor foot biomechanics: individuals with flat feet are at higher risk for plantar fasciitis, and - somewhat paradoxically - so are people with high arches. If you have either low or high arches you should consult a health professional who can recommend whether orthotics are required for your feet. Also, seek good advice about what running shoes are best for you.
Hills or sand training: a sudden increase in hill training may also spark a bout of plantar fasciitis. Be careful to increase the amount of these forms of running to avoid issues with your plantar area. On the sand, be careful of running on the hard sand near the ocean as this is less forgiving than the soft sand.
Pregnancy: pregnancy and plantar fasciitis unfortunately go together like hand and glove! The extra weight of pregnancy adds load to the foot and is a common cause of plantar fasciitis.
Weight gain: gaining weight or being obese is also a strong risk factor for plantar fasciitis. A recent study determined that 77 per cent of its sample of 411 plantar fasciitis (heel spurs) patients were overweight. Another study found that 23 per cent of overweight women had plantar fasciitis (heel spurs) compared to 8 per cent of the normal body-weight group. The additional body mass simply places increased stress on the plantar fascia.
If you have heel pain at the front and bottom of your heel, especially when you first wake up in the morning, it's quite likely that you have plantar fasciitis. If it is indeed plantar fasciitis, putting about an inch of folded paper under your heel or stretching out your calf muscles will usually help diminish the pain. However, other problems sometimes mimic plantar fasciitis discomfort.
Further diagnosis: X-rays and a bone scan can help rule out the possibility of stress fracture, and a nerve study (using electrodes) can eliminate tarsal tunnel syndrome. A bit of arthritis in the heel may resemble plantar fasciitis, but blood tests can help make the diagnosis (there is no blood test for plantar fasciitis, but there is for arthritis). Your doctor may want to perform an MRI to confirm the presence of plantar fasciitis.
The traditional remedies for plantar fasciitis are: stretching the calf muscles, massage, decreasing one's training, losing weight, purchasing better-fitting shoes (with a raised heel and arch support), using special insoles, relying on thick heel pads, icing the sore heel, and gulping down prescription-type doses of ibuprofen / pain killers.
The following self-help treatments for plantar fasciitis have been found to be most effective:
* Rest your foot. Reduce the amount of weight-bearing activities you participate in. Get off of your feet and elevate them. This will allow healing of the fascia to begin.
* Apply ice to your foot. Applications of ice packs that provide a comfortable cooling to the heel and arch (not a freezing cold) will help reduce pain, swelling, and inflammation. Apply the ice to the heel and arch (not the toes). Make sure it is comfortable, and leave on your foot for about 20 minutes, 3 times a day. If you have any medical problems such as diabetes, poor circulation, etc., discuss the use of ice with your doctor before applying the ice.
* Do not walk with bare feet. Always protect your heels, arches, and plantar fascia with good supportive shoes.
* Stretch the plantar fascia while sleeping. Plantar fasciitis and heel spur pain is usually worse with the first steps in the morning. This is due to the Plantar Fascia tightening up, or contracting while we sleep. To prevent these pain producing contractures of the plantar fascia, the foot must be held in its normal or neutral position while we sleep. This optimal post ion of the foot is maintained with our comfortable and supportive Night Splint. When foot contractures are prevented during sleep, the "first step pains" plantar fasciitis and heel spurs will gradually subside. For more information about this uniquely effective and comfortable night splint, click here.
* Stretch the plantar fascia during the day. Even though the plantar fascia is a thick tissue band with very little "give" to it, with the proper care (a Night Splint and the following exercises) it can be stretched a small amount. By stretching the Plantar Fascia even a bit, its abnormal pull on the heel is reduced. This will help to reduce pain and inflammation in the heel and arch. Two of the most effective exercises are:
1. After sleeping or resting, stretch the arch of the foot by stretching your legs out in front of you (do not bend the knee). Place a towel around the ball of the foot. Slowly pull on the ends of the towel, pulling the toes and ball of the foot back as far as is comfortable. Hold the foot in this position for ten seconds. Repeat at least ten times. You should feel a pull on the bottom of the foot, especially in the arch. This stretches the plantar fascia, and reduces its pull on the heel.
2. Stand about 2 to 3 feet from a wall. Lean forward with your hands against the wall. With the painful foot behind, place the other foot forward. Press against the wall, shifting weight over the front foot, while straightening the back leg. Keep the heel of the back foot on the floor and feel the stretch in the heel, Achilles Tendon, and calf. Hold this position for ten seconds. Repeat at least ten times, and try to do this three times a day.
The trouble with these treatments for plantar fasciitis (e. g., stretching the calf muscles, getting a massage, cutting back on training, hitting the non-steroidal anti-inflammatories, and icing) is that they aren't always effective and once you start training or being active again the problems can come back as if nothing had ever been done! We definitely recommend seeing a specialist who has good experience with plantar fasciitis problems!
See our article on a new stretch for plantar fasciitis here!
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