Plantar Fasciitis

Introduction

Do you wake up in the morning and feel like pins are stabbing the bottom of your feet? Or experience some form of pain in the bottom of your foot when you initially get up? Or perhaps after standing for an extended period of time you develop severe pain in the arch of your foot. With 10% of the general population experiencing this pain at some point in their lifetime, it is likely that you or someone you know may be affected by plantar fasciitis.

Who is at higher risk of developing Plantar Fasciitis?

• Those in the 45-64 age demographic. Commonly female.

• Those with flat (planus) or high-arched (cavus) feet

• Long-distance runners (feels pain especially when running downhill or on uneven ground)

• Persons working occupations that demand prolonged periods of standing

• Excessive sudden weight gain due to pregnancy or obesity

• Those with inflammatory arthritis including rheumatoid arthritis (RA)

• Those with diabetes mellitus, hypothyroidism, or osteoarthritis

• Wearing shoes with poor arch support (flip-flops, soft soles, etc.)

What is it?

Plantar Fasciitis (also known as plantar heel pain, heel spur syndrome, or painful heel syndrome) is an overuse injury. Those experiencing a severe case will notice walking barefoot, climbing stairs, or walking on their toes evokes extreme pain.

Let’s break down the term.

In Latin, plantar refers to the sole of the foot (simply put).

Fasciitis can be further broken down into fascia + -itis.

Fascia:

How I often describe fascia to my clients is through analogy. Think of it has saran wrap covering your muscle. Or that membrane surrounding the meat of a chicken breast. It’s a very thin membrane of connective tissue that surrounds your muscles. When you use a foam roller or lacrosse ball you’re activating the fascia. If you’ve ever foam rolled, you’ve likely found a “knot” or tense bundle of ’tissue’ that is particularly sensitive when rolled over. By emitting pressure onto this knot, you’ll eventually feel it release (or reduce tension). This is the fascia that you are working. By keeping your body well hydrated, you’re helping your fascia stay plyable (thus, foam rolling is often less painful when you’ve consumed your 2L of water… you’d think that would be incentive for me to up my intake #slowlearner). This is obviously a VERY simplified explanation, so please remember that the science is very detailed and much more complex.

-itis: a suffix used to describe inflammation.

Plantar + fascia + itis.

Combining these terms, we understand that you have this saran wrap like membrane that connects beneath your foot from your toes to your heel. When we put a lot of weight on our feet (excessive standing, carrying around extra weight, poor footwear not keeping your foot in optimal biomechanical position), this fascia can become tight. Your calf muscle (‘fascia’) may also be tight causing extra strain on the fascia at the bottom of your foot which already acts as a shock absorber and arch supporter. Too much pressure on your feet and damage or tearing can begin to occur. This leads to inflammation which results in the pain and stiffness those with plantar fasciitis experience. [FYI: current literature is suggesting a more accurate name would be fasciosis rather then -itis as the pain is more chronic in nature, and evidence of degeneration rather than inflammation (2014, Schwartz).]

Treatment

Methods range from icing, to corticosteroid injections, to physiotherapy. In a literature review, the most successful form of treatment for long-term results was seen through plantar fascia-specific stretching (2014, Schwartz). Below are some of the most commonly used and evidence-supported stretches that can be performed from the convenience of your home.

SMR: Self Myofascial Release

Before going to bed, and prior to taking your first steps when you wake up, try rolling the bottom of your foot using a glass bottle, soup can, lacrosse ball, or golf ball. Roll the arch of each foot for one minute, 3 times.

Muscle Lengthening: Assisted Calf Stretch

Using a band or towel, stretch out your calf by pulling back on the foot for 30 seconds, rest for 30. Repeat 3 times.

References:

Jacobs, A. (2013). An Evidence-Based Medicine Approach To Plantar Fasciitis.

Schwartz, E. N., & Su, J. (2014). Plantar Fasciitis: A Concise Review. The Permanente Journal, 18(1), e105–e107. http://doi.org/10.7812/TPP/13-113

Thompson JV, Saini SS, Reb CW, Daniel JN. Diagnosis and Management of Plantar Fasciitis. J Am Osteopath Assoc 2014;114(12):900–901. doi: 10.7556/jaoa.2014.177.