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Common Spring Injuries – Plantar Fasciitis
By: Brian Timm PT, MPT, CSCS, Therapeutic Associates Bend Physical Therapy
Most Americans will experience some type of foot or heel pain in their lifetime. In some cases it can become very debilitating. The arch of the foot or plantar fascia is responsible for 60% of the stress applied to the foot during the mid-stance of gait and can sustain 1.7 to 3 times your body weight. (Hicks, 1954).
What is plantar fasciitis?
Plantar Fasciitis involves an increase of pain in the bottom of the foot between the ball and the heel (arch). It is usually associated with some type of heel pain over the calcaneal fat pad as well. It can come on either quickly or gradually over time. Usually the pain is worst in the morning when a person first steps out of bed and begins walking. Patients have described this pain as “burning”, “tearing”, or severe “stone bruise” type feeling in the bottom of the foot. The pain lessens with more walking but usually returns after periods of sitting when a person begins walking again.
What causes plantar fasciitis?
Several different causes can be attributed to plantar fasciitis including increased activities such as running or walking, weight gain, or stair-climbing. In many cases a change in shoes can cause it to occur. At this time of year most people have been fairly sedentary, wearing heeled shoes and boots, and have gained some weight over the winter. They begin an exercise routine (often walking or running), switch to flatter sandals or flip-flops, and are heavier from the holidays and winter. This makes for a perfect combination to get some sort of foot or heel pain. Runners usually begin changing their workouts to include more mileage and intensity. Others begin walking Pilot Butte more often which adds increased load on the foot and ankle structures. The change from a full supportive shoe with a heel to a flat flip-flop or sandal or walking barefoot can increase symptoms quickly.
How is it treated?
Treatment is varied depending on the cause, symptoms, and severity of the condition. In severe cases the patient is placed in a walking boot to allow the structures to calm down followed by physical therapy to gradually stretch and strengthen the tissues. Most cases are treated with stretching exercises for the calf and foot, reduction in activities, and use of ice or ice massage or anti-inflammatory medication . Often specific taping techniques such as Lo-dye or Kinesiotaping are very helpful as well as off- the- shelf or custom foot beds. A night splint or specific sock to keep the ankle at 90 degrees while sleeping is also often utilized. Surgery is limited to extreme cases and is usually not recommended. Even without any specific treatment, the condition will usually resolve itself over of a year but most people seek treatment before this due to the pain and limitations it places on their activities.
Prevention
Regular stretching of the calf muscles (multiple times during the day) as well as dynamic warm-up or stretching before activities is very important in the prevention of plantar fasciitis. In addition stretching the hamstrings and other hip musculature is also important. In a recent study in 2011, patients with hamstring tightness were about 8.7 times as likely to experience plantar fasciitis symptoms (Labovitz, 2011). Stretches should be held for a minimum of 30 seconds but longer periods provide more benefit. Dynamic stretching is important for runners and other athletes but caution must be taken to perform these correctly. Other important prevention strategies include use of proper foot wear, gradual increase in exercise or training volume and intensity, along with strengthening of foot and ankle musculature.
References
Hicks, JH: The mechanics of the foot. II. The plantar aponeurosis. J Anat 80:25, 1954.
Labovitz, J and Kim,C. The Role of Hamstring Tightness in Plantar Fasciitis. Foot Ankle Spec. March 2, 2011.
Common Spring Injuries – Plantar Fasciitis
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