Plantar fasciitis; often referred to as the painful first step in the morning. Can you picture it? The alarm goes off, you groggily hit the off button (unless you’re a snoozer; you know who you are), you throw the blankets off, swing your legs over to place your feet on the floor and…AHH! Pain shoots through the bottom of your foot. Not exactly the best way to start off your morning. So what is it exactly that causes such an awful reaction to such a simple movement? The plantar fascia is a ligament that originates at the base of the toes, running along the bottom of the foot, and attaches to the heel, which is the calcaneus, and helps to maintain the arch of the foot.
Plantar fasciitis should be diagnosed by a podiatrist, but there are some identifying factors:
A painful first step in the morning, or after periods of inactivity, that will disappear shortly after walking around.
Falling of the arch followed by the falling in of the ankle.
The formation of a bone spur in the heel of the foot.
Plantar fasciitis, more common in women, is often brought on during the summer time when athletes and runners pick up their game after a long winter and start running and working out more frequently. Although it can be seen in individuals who stand most of the day, especially military personnel, it is an injury caused by overuse and is exacerbated by a number of factors including poor footwear, tight calf muscles, being overweight, and high or flat arches. As the arch falls from laxity of the fascia, the foot begins to flatten to the floor causing the ankle to fall in on itself. As the ankle falls inward, the fascia is stretched from the lengthening in the arch. Because the fascia is meant to be flexible, and not meant to be stretched, you start to feel the pain in your foot, usually beginning at the heel. When the arch and ankle fall, a bone spur will often form on the bottom of the heel, meant to give length to the fascia and ease the pain of the pulling ligament. This spur is another of the body’s ways of compensating for the falling arch and stretching of the fascia, but is only a temporary fix to the problem.
Inserts/Orthotics – One of the most common ways to treat plantar fasciitis is shoe inserts. These inserts should be custom fit to the patient’s shoes for the most benefit. For at least 2-4 weeks these inserts must be worn all the time in order to make a difference, with the exception of in bed and the shower. There are also orthotics made for wearing in bed for the added support, but many find them uncomfortable and prefer not to use them, and opt for taping instead.
Taping – “Tape can be applied in a number of ways which all basically take the strain off the plantar fascia relieving pain and allowing it to heal.” (http://www.sportsinjuryclinic.net) It is important to find someone who has been trained in proper taping techniques, as improper taping can result in the formation of blisters, and would be ineffective in treating plantar fasciitis.
Massage – Massage therapy is another great way to ease the pain of plantar fasciitis. Gently working the plantar fascia helps break up adhesions and increase the flexibility in the ligament, while work on the calves releases tension placed on the Achilles tendon and calcaneus, where the plantar fascia attaches to the heel.
Stretching – As mentioned before, fascia is NOT meant to stretch, but light stretching techniques can help to increase the flexibility of the fascia and relieve some of the strain and pulling from the ligament. It is very important not to overstretch the fascia in order to avoid further damage.
Ice Compress – Ice is almost always a good idea in terms of treating pulls or strains, and plantar fasciitis is no exception. It helps manage pain, increases circulation in the area when used in conjunction with heat, and reduces swelling in cases of repeated plantar fasciitis injuries.
Surgery – In severe cases, or repeated injury, an endoscopic plantar fasciotomy can be performed to release the fascia, but should only be used as a last resort in attempting to restore proper function to the plantar fascia.
These treatments can significantly help reduce the pain, and speed along the healing process of plantar fasciitis, but a diagnosis should first be made by your health care provider.