plantar fasciitis, heel spurs, foot pain; Pro-Am Sports Injury Clinic

Plantar Fasciitis

The plantar fascia and area of pain under the heel in plantar fasciitis

Plantar Fasciitis is a painful condition affecting the plantar fascia or arch of the foot.

It is a thick broad band of tissue spreading from the heel of the foot to the base of the toes.

Plantar fasciitis can lead to a heel spur. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present through repetitive pulling of the plantar fascia on the foot, the body lies down extra bone to heal the site from micro trauma. A person can have no symptoms at all when a heel spur is present and a painful heel does not always have a heel spur present.

Plantar fasciitis is traditionally thought to be an inflammatory condition. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain and dysfunction is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone). It is also commonly present with achilles problems, tight calf muscles, and foot alignment problems, all four can coexist together.

What are the Signs and Symptoms?

Heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.

Pain when pressing on the inside of the heel and sometimes along the arch

Pain is usually worse first thing in the morning as the fascia tightens up overnight. After a few minutes it eases as the foot gets warmed up

As the condition becomes more severe the pain can get worse throughout the day if activity continues.

Stretching the plantar fascia may be painful.

Sometimes there may also be pain along the outside border of the heel. This may occur due to offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.

Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping. Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot causes additional stretching of the plantar fascia.

What Causes Plantar Fasciitis?

The most common cause of plantar fasciitis is very tight calf muscles which leads to prolonged and / or high velocity pronation of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength.

Some practitioners think overpronation can always be determined by the dropping and rolling in of the arch. This is not always the case. Sometimes it can only be seen with foot scans, especially if the patient has a high arched foot.

Other causes include high arch or low arch feet (pes cavus / planus) and other biomechanical abnormalities including oversupination which should be assessed by a podiatrist / biomechanist.

Excessive walking in footwear which does not provide adequate arch support has been attributed to plantar fasciitis. In addition, overweight individuals are more at risk of developing the condition due to the excess weight impacting on the foot.

How is Plantar Fasciitis Treated?

What can the athlete do?

Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation. Rest as much as possible and stop any unneccessary activities which place additional stress on the fascia. Cross train using swimming or cycling so fitness is not lost, strength and flexibility work can still be kept going.
A good plantar fasciitis taping technique can help the foot get the rest it needs by supporting the plantar fascia. Tape is applied in strips across the plantar fascia taking the stress off the foot.
Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved. A cold can rolled under the foot is quick and easy is apply.
Stretching the plantar fascia and calf muscles is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The plantar fascia tightens up making the origin at the heel more susceptible to stress.
A plantar fasciitis night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

What can a sports therapist do?

Refer you for gait analysis to determine if you overpronate or oversupinate. A Podiatrist will prescribe orthotics or insoles. An insole can restore normal foot biomechanics if overpronation is a problem.
Tape the foot and instruct the athlete how to tape the foot. This is an excellent way of allowing the foot to rest.
Apply sports massage techniques to reduce the tension in the plantar fascia and also stretch the calf muscles.
Refer you for an X ray to see if there is any bone growth (calcification). An X-ray may be able to show bone growth which may be a cause of pain but research has shown that the presence of a bony growth does not necessarily mean the athlete will feel pain. Bony growth can worsen even after symptoms have completely resolved. If it is believed to be a problem then they will operate if symptoms do not resolve. This is more common for patients with a rigid high arch where the plantar fascia has shortened to benefit from surgery.

What will the therapist look for when assessing the foot?

Observe posture
The therapist should observe the position of the patient in both standing and walking, paying particular attention to the arch of the foot, looking for fallen arches, a high arch, overpronation and oversupination. If you are a runner then looking at your trainers can give an idea of running wear patterns.

Palpation
The therapist will usually palpate, or feel, the area, including the heel and arch of the foot. Pain on palpation of the inside of the heel or arch can indicate plantar fasciitis

Range of motion
A decreased range of motion at the ankle can contribute to developing plantar fasciitis. The therapist should pay particular attention to the amount of dorsiflexion (pointing the foot up towards the ceiling) as a decreased range here can indicate tight calf muscles. A normal range of motion should comfortably allow a 90 degree angle between the lower leg and foot.