The plantar fascia is a band of connective tissue that runs along the sole from the heel to the ball of the foot. One of its main roles is to keep the bones and joints in position. Bruising or
overstretching this ligament can cause inflammation and heel pain. A common cause is flat feet, because the ligament is forced to overstretch as the foot spreads out and the arch flattens. The pain
may be worse first thing in the morning or after rest. In many cases, plantar fasciitis is associated with heel spur. The plantar fascia tears and bleeds at the heel and, over time, these injuries
calcify and form a bony growth.
Plantar Fasciitis is caused by abnormal pronation of the foot. Contributing factors are obesity, weight gain, jobs that require a lot of walking or standing on hard surfaces, badly worn shoes with
little support, and also inactivity. As a result of over-pronation, with every step the Plantar Fascia (band of tissue under the foot) is being stretched, resulting in inflammation, irritation and
pain at the attachment of the fascia into the heel bone. In some cases the pain is felt under the foot, in the arch. Continuous pulling of the fascia at the heel bone, eventually may lead to the
development of bony growth on the heel. This is called a heel spur. When youâre at rest, such as while sleeping, the Plantar Fascia tightens and shortens. When body weight is rapidly applied to the
foot, the Fascia must stretch and quickly lengthen, causing micro-tears in the Fascia. As a result, the foot pain is more severe with your first steps in the morning, or after sitting for a long
period. Plantar Fasciitis is more likely to happen if you suffer from over-pronation (flattening of the arch), you stand or walk on hard surfaces, for long periods, you are overweight or pregnant,
you have tight calf muscles.
The classic sign of plantar fasciitis is that the worst pain occurs with the first few steps in the morning, but not every patient will have this symptom. Patients often notice pain at the beginning
of activity that lessens or resolves as they warm up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness. In more severe cases, the pain will also worsen toward
the end of the day.
Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have
to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after
walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable
making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing
Non Surgical Treatment
First check your shoes for too much midfoot flexibility and check your training for changes. A detailed evaluation of changes in your training is necessary. You should start with what is called
"relative rest" which means a decrease in workout intensity, duration of session and decrease in the number of sessions per week. The most important part of self treatment for this condition is being
sure that your shoes offer sufficient stability and are optimal in controlling the forces that contribute to plantar fasciitis and heel spurs. Check your running shoes to make sure that they are not
excessively worn. They should bend only at the ball of the foot, where your toes attach to the foot. This is vital! Avoid any shoe that bends in the center of the arch or behind the ball of the foot.
It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this. You should also be doing gentle calf
stretching exercises. This will reduce stress on the plantar fascia in two ways. The first manner in which a relaxation of the tension in the calf muscles can help heel pain is that it will reduce
the direct pull backwards on the heel bone (calcaneus). The second reason is a little bit more complicated, but essentially it is that a tight achilles tendon and calf muscles causes the rearfoot to
move in a manner that causes over pronation as your leg and body move forward over your foot. So go ahead and gently stretch the calf muscle by doing the runner's wall leaning stretch. To strengthen
the muscles in your arch toe curls or "doming" can be done. Toe curls may be done by placing a towel on a kitchen floor and then curling your toes to pull the towel towards you. This exercise may
also be done without the towel against the resistance of the floor.
When more conservative methods have failed to reduce plantar fasciitis pain, your doctor may suggest extracorporeal shock wave therapy, which is used to treat chronic plantar fasciitis.
Extracorporeal shock wave therapy uses sound waves to stimulate healing, but may cause bruises, numbness, tingling, swelling, and pain. When all else fails, surgery may be recommended to detach the
plantar fascia from the heel bone. Few people need surgery to treat the condition.
You can help to prevent plantar fasciitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch and cushion the heel. In people who
are prone to episodes of plantar fasciitis, exercises that stretch the heel cord (known as the Achilles tendon) and the plantar fascia may help to prevent plantar fasciitis from returning. Ice
massage also can be used on the bottom of the foot after stressful athletic activities. It is possible that strict control of blood sugar will prevent plantar fasciitis in people with diabetes,
although this has not been proven.