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Core Knowledge

Injury/Pain

Plantar Fasciitis 101

Overview

Plantar fasciitis is an inflammation of the fibrous tissue (called plantar fascia) that runs along the bottom surface of your foot, from your heel to the base of your toes. The longer the inflammation lasts, the more likely that the lining of the foot will also be torn away. The structure that develops when that happens is as wide as the heel bone and is known as a heel spur or stone bruise. Technically, there is a difference between the two conditions, but plantar fasciitis and heels spurs are often used to mean the same thing.

How It Occurs

There are only theories of how it develops, and it can materialize in various situations, but the consensus of opinion is that a cumulative overload on the feet causes microtears and degeneration of the plantar fascia tissue.

  • Overuse following a change in training methods is thought to be a common contributing pattern among athletes.
  • There is limited evidence that making quick turns, which places additional stress on the foot, can result in plantar fasciitis.
  • Tight calf muscles cause a lack of flexibility, which in turn, may also lead to the condition.
  • Being flat-footed or having an abnormal walking pattern may distribute the weight in a manner that makes a person more susceptible to tiny muscle tears and inflamed plantar fascia tissue.

Other contributing factors may include excessive foot pronation (ankle rolling inward), shoes worn at the heel, and running on uphill surfaces.

By the Numbers

2,000,000
Number of Americans affected by plantar fasciitis each year.

85
Percentage of cases of plantar fasciitis in which the exact cause is unknown.

10
Percentage of running-related cases of plantar fascittis.

14
Percentage of patients, according to one study, who improve plantar fasciitis symptoms simply by changing athletic shoes.

40-60
Age range at which the incidence of plantar fasciitis occurs most frequently.

Who’s At Risk

Runners and joggers are most susceptible, but anyone with tight calf muscles is in a higher risk group due to a lack of flexibility. People who have flat feet are also more prone to the condition. Women are more likely to develop plantar fasciitis than men, and finally, being overweight is a risk factor for all groups.

Symptoms

  • Gradual onset of heel pain
  • Feeling of a bruise deep in the heel
  • Pain is more evident in the morning; less during the day
  • Pain is more likely after exercise than during it
  • Pain when standing up after a midday break
  • When a heel spur is present, you can feel a bump at the point of pain

Initial Treatment

  • Rest to keep weight off the foot until inflammation subsides
  • Ice applications for 15-20 minutes at a time, 3-4 times a day
  • Ibuprofen, acetaminophen, aspirin, or naproxen for pain relief and reduction of inflammation

Comeback Strategy

Continue an exercise program, but not with activities that put pressure on the heel. (Riding a stationary bicycle and swimming are two options.)

Prehab

Incorporate these prehab exercises recommended by Athletes’ Performance physical therapist, Anna Hartman.

  1. Tennis Ball Arch Rolls
  2. Massage Stick/Tennis Ball Lower Leg (self massage to the lower leg, focusing on the inside of the shin and deep in the calf)
  3. Seated Toe Flexion and Extension Stretch- Seated with leg crossed in both plantar flexion and dorsiflexion manually take the toes and stretch them into flexion and extension.
  4. Standing Ankle Dorsiflexion Stretch (for neutral and internal rotation; traditional calf stretch while maintaining a good arch position with foot straight ahead and foot turned in with hips square to the wall; often people will turn their feet out and not feel much of a stretch)
  5. Eccentric Calf Raises (start with two-feet calf raise maintaining a neutral foot position; raising up over 1st/2nd toe, then shift weight to one foot and slowly lower down. Hold on to the edge of a counter or a bar or support; two sets of 10)
  6. Intrinsic Towel Crunches in Plantar Flexion (seated, starting with the ankle in front of your body with ankle plantar-flexed on top of a towel; use toes to crunch up towel; two sets of 25)
  7. Intrinsic Toe Toy Pick Up (use toes to grasp and pick up golf tees or marbles from one pile to another; see how many you can move in five minutes) 

How to Avoid This Injury

  • Wear shoes that fit properly and give adequate support to the arches.
  • Change running or walking shoes every 300-500 miles.

Movement Prep

Incorporate these exercises into your dynamic warm-up routine to help prevent plantar fasciitis:

  1. Rapid Response 2-Inch Runs
  2. 1 Leg Stepover Runs - Shin
  3. Wall Drill - Load and Lift

Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.


Tags: Injury, Prehab, Rehabilitation, Running, Foot, Injury Prevention, Triathlon, Regeneration, Foot Pain

References

  1. Anna J. Hartman, MS, ATC, CSCS, Manager, Performance Physical Therapy Services, Athletes’ Performance, Phoenix, Arizona
  2. American Academy of Orthopaedic Surgeons
  3. eMedicine.com
  4. National Institutes of Health (Medline Plus)
  5. Sports Injuries: Prevention, Treatment, and the Healing Process (The Cleveland Clinic)

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