Plantar Fasciitis

Do your first few steps out of bed in the morning cause severe pain in your heel? Or does your heel hurt after jogging or playing tennis?

Plantar fasciitis usually presents in one of two forms: a generalized type which involves an area in the mid arch area of the foot (commonly associated with a flat foot), and a localized type which usually involves the plantar aspect of the heel (commonly associated with a heel spur). The treatment, (below), of these two types of fasciitis is essentially the same.

In most cases, you can overcome the pain of plantar fasciitis without surgery or other invasive treatments. You can take steps to prevent plantar fasciitis from recurring.

Symptoms

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. Although it can affect both feet, it more often occurs in only one foot at a time. Watch for:

• Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot.
   
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe.
   
• Heel pain after long periods of standing or after getting up from a seated position.
   
• Heel pain after, but not usually during exercise.
   
• Mild swelling in your heel.

Causes

• Physical activity overload. Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
   
• Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
   
• Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.
   
• Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're on your feet, putting added stress on the plantar fascia.
   
• Improper shoes. Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don't protect your feet. If you regularly wear shoes with high heels, your Achilles tendon, which is attached to your heel can contract and shorten, causing strain on the tissue around your heel.

Risk Factors

• Active in sports. Activities that place a lot of stress on your heel bone and attached tissue are most likely to cause plantar fasciitis. This includes running, ballet dancing and aerobics.
   
• Flat-footed or have high arches. People with flatfeet may have poor shock absorption, which increases the stretch and strain on the plantar fascia. People with highly arched feet have tighter plantar tissue, which also leads to poor shock absorption.
   
• Middle-aged or older. Heel pain tends to be more common with aging as the arch of your foot begins to sag, putting stress on the plantar fascia.
   
• Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.
   
• Pregnant. The weight gain and swelling that accompany pregnancy can cause ligaments in your body, including your feet, to relax. This can lead to mechanical problems and inflammatory conditions.
   
• Being on your feet. People with occupations that require a lot of standing on hard surfaces, or walking, including factory workers, teachers and waitresses, can damage their plantar fascia.

• Sandals.
   
• Loafers (moccasins, deck shoes).
   
• Badly worn shoes.
   
• Shoes with little or no arch support.
   
• Shoes with a flexible shank (the shank is the middle part of the sole, immediately in front of the heel).

1. Do not wear shoes in the house. Going without shoes helps "rebalance" the feet.
    
2. Gently stretch your calves. Runners typically get PF because they get tight calves and/or overstretch (or bounce stretch).
    
3. Rest! Whatever you are doing, change it.
    
4. Use an anti-inflammatory like Ibuprofen.
    
5. Measure your body fat. If it's in the double digits, you are too fat. To fix that, eat smaller portions.
    
6. Examine the soles of your shoes. If the wear pattern is not perfectly flat, you have a posture problem and/or a foot alignment problem. Pronation is the most common such problem.

• Step stretch. This is a great stretch to do. Begin by finding a step, curb, and something you can hold onto to maintain your balance. Remember to slowly ease into the stretch. Bouncing may cause further trauma to the area. Balance yourself on the balls of your feet. Slowly allow your body weight to gently stretch the calf muscles until you feel tension. Hold this position for thirty seconds.
   
• Wall stretch. While wearing shoes, locate a doorway. Reach through the doorway so that you can balance yourself. Position one of your feet so that the ball of the foot is firmly against the wall. The heel of the foot is firmly pressed into the ground. Begin to slowly apply pressure by pulling your body towards the wall, making your lower leg more perpendicular to the floor. Repeat with the other foot.

Prevention

To avoid re-injuring the fascia and causing further pain, the APMA has the following recommendations:

• Always consult a foot specialist before starting a new exercise program.
   
• Allow your body to adapt to the exercise program by starting slowly. It takes time for the body to adapt to the additional stress.
   
• Purchase and maintain good shoes and replace them regularly. Investing a little more money in good shoes will pay dividends in pain-free living.
   
• Remember to stretch your feet and Achilles tendon before and after exercise.
   
• Always try to exercise on an even surface. Uneven surfaces can but strange stressed on the foot and can result in pain.
   
• Avoid walking barefoot on hard surfaces. Without your shoes, you fascia has to support your entire body weight.
   
• If it hurts, STOP. Don't try to bear through the pain.
   
• If you don't see much progress after a few weeks of home treatment, see your family doctor or a foot doctor (podiatrist).
   
• Seek help sooner if your pain worsens, despite home treatment. If you have diabetes or another condition that causes poor circulation, see your doctor for an early evaluation of any changes in your feet.

See our other articles for nutrition and training tips that will help you prevent plantar faciities and a host of other painful conditions.