Plantar Fascitis

Time for a short Latin lesson. In Latin, 'itis' means inflammation so whenever you see a syndrome ending in 'itis' you automatically know that it's some kind of inflammatory condition. So, 'fascitis' means inflammation of some sort of fascia - that is, the tough fibrous outer casing of some muscle. 'Plantar' refers to the foot, or more specifically the part of the foot we 'plant' when we walk - i.e. - the bottom of the foot. So Plantar Fascitis is an inflammatory condition affecting the fascia on the bottom of the foot. This is a particularly bothersome condition that has been know to hobble many elite athletes. If addressed early it is much easier to remedy than if it's left to develop into a chronic condition.

The Anatomy (images)

The plantar fascia originates on the front of the heel and runs lengthwise along the sole of the foot. It's related to the plantar muscles of the foot which curl the toes under and help support the arch of the foot. Now, the arch of the foot is supported primarily by the shape of the bones of the foot - the muscles don't have to do a whole lot to maintain the arch. However, sometimes over time the arch starts to collapse a bit which can cause the plantar fascia to become over stretched. This can often lead to inflammation and pain in the plantar fascia.

There are numerous factors which have to be accounted for when assessing the cause of plantar fascitis. Shoes, type of work, running habits and patterns and foot mechanics are all possible contributing causes of plantar fascitis.

Signs and Symptoms

  • Pain on the sole of the foot, often localized to the front of the heel

  • Pain is usually worse first thing upon arising in the morning. The first steps of the day are often the most painful.

  • Pain often aggravated by standing, walking or running, with running being the most painful.

What's Going On

For whatever reason, the plantar fascia has become inflamed and every time you stand on it you stretch that inflamed muscle. Pain is usually worse in the morning because during the night the muscle will often get tighter. The muscle shortens when we curl our toes or point our feet. While sleeping our feet are often in a position whereby the feet are pointed and this allows the plantar fascia to tighten. When we step out of bed in the morning the muscle is suddenly stretched and we feel extreme pain

When plantar fascitis becomes chronic a bone spur will often develop. Bone spurs are easily detected on x-rays. Bone spurs develop because the plantar fascia has pulled for a long period of time on it's attachment to the heel and the bone of the heel has reacted to the stress by depositing calcium at the attachment.

What To Do About It

As stated earlier, you really have to catch plantar fascitis before it becomes chronic so that you don't develop bone spurs. Don't wait in hopes that the pain will go way on it's own because early treatment is the most effective.

Treatment is variable but may consist of ultrasound, current, orthotics, manipulation of the bones of foot and home stretching and exercise. Some of the most useful home treatments are as follows:

  • Ice - this is the most important thing you can do for yourself. Either an ice pack under the sole of the foot of take a frozen can of juice and roll in under your foot to do a bit of ice massage.

  • Home exercises to strengthen the plantar muscles - practice picking a golf ball up with your toes, or lay a towel on the floor and scrunch it up with your toes.

  • When severe, bracing at night may be necessary - because things tighten up when we point our toes at night sometimes a splint which holds the foot in dorsiflexion (toes up) may be necessary. Commercial ones are available but one of the best ways to splint your foot is to sleep with a boot on your foot. A ski boot works great because it won't flex at all but any high, stiff boot should suffice. It may seem clumsy but I've had patients who've found this was the trick in fixing their foot.

  • Soak with Epson salts - once again, hot water and Epsom salts will draw inflammation out of the sore muscles.

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