Plantar Fasciitis (Short Version)
This series of educational material is a broad overview of foot problems, and not as detailed as an actual podiatrist visit. I recommend you to see a podiatrist for professional evaluation of your foot and ankle problems. This is for educational purposes only.
This material is from my own experiences seeing patients. Other podiatrists may have different recommendations. Each examination has nuances and details too small to mention in this type of presentation.
What is Plantar Fasciitis?
Along the bottom of the foot, from the heel to the ball of the foot, is a thick band of tissue that helps keep the arch of the foot up. Due to all the stress this band of tissue undergoes it can develop tiny tears in it. These tiny tears are normally healed throughout the day and during sleep. But sometimes the healing process does not keep up with your activity level, and those tiny tears become painful. Most of the time this occurs where the fascia (thick band of tissue) attaches to the heel bone. Sometimes it occurs under the midfoot and rarely near the ball of the foot.
You will notice the attachment is not under the center of the heel, but towards the inside of the foot. The big toe is on the inside of the foot, and the pinky toe is on the outside of the foot.
Causes
Plantar fasciitis is caused by stress and stretching of the plantar fascia on the bottom of the foot. The plantar fascia is stressed by flattening the arch of the foot. Little tiny tears develop in the fascia as people bear weight. This is normal and the body is constantly repairing itself. But sometimes during the repair process the body gets stuck in the inflammatory part of the repair process, and this is when it gets painful.
There are two main causes of stress on the plantar fascia, activity and structural. A minority of cases are caused by direct trauma, such as stepping on a Lego, a rock, or falling onto the feet from a height.
Activities that flatten the arch include walking, running, jumping, standing, standing on ladders, and carrying heavy objects.
Structural. People with high arched feet or flat feet both have abnormally high levels of stress under the foot. Another structural issue is something called equinus. This is when the calf muscles are too short, and in turn, prevents the ankle from letting the foot go up. By preventing the foot from dorsiflexing, or going up, it causes a large amount of stress that flattens the foot.
There is one factor that makes every situation worse, and that is being overweight. In every instance whether structural, activity, or trauma, being overweight can impede the healing process and can cause problems to return after a successful treatment.
Heel spurs do not cause plantar fasciitis. Removing heel spurs can get rid of plantar fasciitis, but the spur itself does not cause plantar fasciitis.
Symptoms
The distinguishing feature of plantar fasciitis is pain when first standing in the morning and standing after rest. The bottom of the heel, and sometimes midfoot, will be most painful upon standing and then decrease over the next few minutes as a person walks it out and stretches out the bottom of the foot.
Pain is mostly located on the bottom of the heel towards the inside of the foot. It can also extend toward the arch and rarely the pain is just under the midfoot and not at the heel at all.
A podiatrist may check the structure of your foot while standing and while sitting. Plantar fasciitis in flat feet and high arched feet are, for the most part, treated the same; but severe deformities could lead to a whole other type of treatment plan that will not be discussed here.
Another factor to check is the calf muscle group. The ankle range of motion is important to note. Does the forefoot go up high enough? If not, this will significantly increase pressure that flattens the foot, and may need to be addressed by surgically lengthening those muscles or tendons. It is a relatively easy and highly effective procedure but is not appropriate for everyone.
Treatment
Plantar fasciitis is most often caused by pulling of fascia on the heel bone. The goal of treatment is to decrease this pulling action and allow the body time to heal itself. We will also discuss options that target inflammation directly.
The treatment plan I recommend is composed of 6 parts. Parts 1-4 are all recommended at the first visit and to start at the same time. Part 5 is optional but recommended. Part 6 is between you and your physician.
Part 1: Stretching
Stretch 5 times a day for 30 seconds each. The goal is to stretch the plantar fascia into a more lengthened position. The fascia heals during rest in a shortened position and gets restretched each time a person stands. This isn’t going to over-flatten the foot. It is going to help prevent the healing process from over shortening.
Part 2: Arch supports
Arch supports are used to help support the arch during weightbearing activities and take some pressure off the plantar fascia.
Part 3: Ice and/or Frozen water bottle rolling
Ice is used to decrease inflammation.
If using a frozen water bottle this can perform both icing and rolling functions at the same time.
Part 4: Steroid Injection and/or Anti-inflammatory Medication.
These directly target inflammation, decrease pain, and help the body turn off the inflammatory process. You can only get a steroid injection from a physician/podiatrist.
Part 5: Night Splint
Night Splints keep the foot at a 90 degree angle to the lower leg while sleeping. This allows the plantar fascia to heal at night time in a longer position instead of being over shortened by a relaxed sleeping foot.
Part 6: Surgery
If there is no improvement after 12 months of treatment consider surgery. Discuss this with your physician for more information and their treatment plans and preferences.
