Plantar Fasciitis

Plantar fasciitis is a condition of the foot that results from the repetitive overstretching and irritation of the plantar tissue, a relatively stiff, fibrous material that connects the calcaneus (heel bone) to the ball of the foot. The term plantar fasciitis is often used interchangeably with another foot and heel condition, heel spurs, and while the two have a similar origin, they are not always the same ailment.

Plantar fasciitis occurs during athletic activity as a result of how the foot responds to the stresses of either walking or running. During either motion, movement begins with a pushing off from the pads at the ball of the foot and a lifting of the heel. The heel is connected to the calf muscles (the gastrocnemius and the soleus) through the Achilles tendon. If the lower leg structure is overly tight, the plantar cannot move easily and it becomes more rigid along its length. The repetitive nature of this tension imbalance between the calf muscles and the plantar is the most common cause of plantar fasciitis. The condition will often cause significant pain, which is chiefly experienced on the sole of the foot closest to the heel. In many cases, the pain is sufficiently acute to limit the training of an athlete, as full intensity running is not possible.

Other factors that may contribute to plantar fasciitis are poor support for the arch of the foot (combined with either high arches or low arches in the subject foot), inadequate cushioning in the footwear used for running on hard surfaces, a sudden increase in either training intensity or workloads, and being overweight. Each of these factors acts on the plantar structure in the same fashion as the lower leg muscle imbalance.

In as many as 70% of plantar fasciitis cases, heel spurs will develop on the affected foot. A heel spur is a deposit of bony material that accumulates on the surface of the heel; in most cases the heel spur is not the cause of pain in the affected foot.

Once the condition of plantar fasciitis has been determined, the person will often notice that the pain is more pronounced in the early morning than at any other time. This is due to the fact that, at night, the plantar tends to contract during sleep, and the tissue takes time, through movement and stretching, to become more pliable and less restricted.

The most effective manner of dealing with plantar fasciitis is a modified version of the RICE (rest/ice/compression/elevation) treatment. The first and most important component in the treatment of plantar fasciitis is to rest from the activities that have contributed to its formation. Runners and other athletes for whom the striking of a surface with their foot is the essence of their training often cross train through swimming, a sport that does not aggravate the plantar tissue, until the condition has resolved itself. Ice on the affected area will assist in management of the condition, and should be applied as soon as there is pain, with the icing repeated up to eight times per day, for a maximum of approximately 15 minutes per session (the ice pack should be applied so that the skin is not at any risk of freezing, but the pack should be cold enough to promote the reduction of swelling and to reduce the risk of scar tissue formation.

As plantar fasciitis is commonly caused by calf muscles that are too tight, a daily stretching program involving those muscle, the Achilles tendon, and the foot is an excellent rehabilitative and preventive step. Also, pressure, or compression, by applying athletic tape or compression bandages over the affected area provides both support for the plantar tissue but also assists in keeping the foot stable through movement. The application of pressure will also combat any lingering tightness present in the calf muscles that tends to counter the rehabilitation of the plantar. The foot and heel can be taped so as to provide one contiguous support structure.

There are measures to be taken once the plantar fasciitis has been controlled. In some cases, an investigation of how the person's foot moves during athletic activity will suggest that either an arch support or an orthotic be crafted to stabilize the motion of the foot when it strikes the ground. Only in the rarest of circumstances will surgery be recommended to correct plantar fasciitis. This procedure involves making an incision into the plantar tissue, with a goal of making the plantar less rigid; such procedures are not a guarantee of improved, pain-free motion.

SEE ALSO Bone, ligaments, tendons; Foot: Anatomy and physiology; Heel spurs; Musculoskeletal injuries.