Plantar fasciitis usually presents as pain in the arch of the foot or on the underside of the heel. The pain is often worst during the first few steps in the morning or after sitting for extended periods as the fascia tightens up overnight or while in a non weight bearing position. The pain may cause runners to cut their long runs short due to the increase in heel or arch pain. As the condition worsens the pain may be felt throughout the day. Left untreated for extended periods of time may actually lead to the formation of a heel spur where the plantar fascia tissue inserts onto the bottom of the heel bone (calcaneus). Plantar fasciitis is most common in sports which involve running, dancing or jumping. It occurs most frequently after an increase in training mileage or intensity.
Anatomy: The plantar fascia is a fibrous band that runs from your heel to the ball of your foot. It is one thick band at the heel that splits into five sections that attach to the metatarsal heads.
What causes the inj
ury? Plantar fasciitis is usually an overuse injury. With every step we make our foot pronates to absorb the impact of our weight hitting the ground. Each time the foot pronates it places stress on the plantar fascia. This fibrous band lacks flexibility and as such is prone to tear if an undue amount of stress is placed on it. Many people that suffer with plantar fasciitis actually overpronate which increases the amount of stress on the fascia. After the fascia is injured it repairs itself with scar tissue. Scar tissue is easily inflamed and is even less elastic than the fascia. As a result it is even more prone to rearing and a nasty cycle develops. Tightness in the calf muscles (both gastrocnemius and soleus) also contribute to this injury as they pull on the calcaneus, effectively causing the plantar fascia to be even tighter.
How is it Treated? There are a number of aspects involved in the treatment of plantar fasciitis. Rest is imperative with this injury to allow healing to begin. Runners are often encouraged to water run, cycle or swim rather than run until the pain has subsided. Initially ice and anti-inflammatories are used to decrease the inflammation. Ultrasound and myofascial release therapies help to break up the scar tissue that has formed along the fascia. This helps restore the normal cellular structure and alignment of the fascia and its regular inherent elasticity. A thorough examination and gait analysis should be performed to determine the need for specific pronation control shoes or orthotics. Taping the arch of the foot to provide support for the fascia is often helpful in the initial stages of treatment. Flexibility exercises are crucial for long term success of a treatment program. Stretching of the plantar fascia, the calf muscles and the hamstrings helps decrease the stress on the plantar fascia. A night splint will prevent the fascia from tightening up overnight to decrease the re-injury and pain felt during those initial steps in the morning. Towel exercises are very beneficial for strengthening the foot. In this exercise the patient is seated on a chair with a towel laid on the floor under their foot. Curl the toes to pull the towel towards you. Afterwards, used your toes to push the towel away from you.
In severe cases, anti-inflammatory injections such as cortisone shots may be required to reduce the inflammation. In the worst cases surgery may be a last resort to ultimately relieve the problem.
As a runner and triathlete I have had to deal with most running injuries myself at some time during the last 20 years. As with many injuries it is not just the treatment modalities used but how and when they are used for the treatment to be most effective. As a Certified Chiropractic Sports Physician I have acquired extensive post graduate training to determine the treatment protocol best suited to your specific case. Not only to alleviate the pain but to prevent the problem from reoccurring again in the future.
On August 28th Kylie and I traveled up to Penticton, BC to volunteer at Ironman Canada and register for next years race. We were also able to cheer on many of our friends who were competing this year. While Kylie worked in the transition area helping athletes with their bikes I had the opportunity to work in the Ironman Medical Tent. As you can imagine, there were more than a few athletes that required our attention after an event of this magnitude. Each athlete was quickly assessed after they crossed the finish line to determine whether they needed to head into the medical tent or if they could go to the food and massage area. I worked in the first area of the tent where we monitored each athlete, taking vitals, making sure they replenished their fluids and arranging for their dry cloths to be sent to the tent. Once they stabilized and could get up and around on their own we would release them. If they wouldn’t improve or started to deteriorate we would have them taken over to the other side of the tent where the medical staff could arrange IV’s, medications or transport to an area hospital if needed.
