Plantar Fasciitis

Plantar fasciitis is the most common cause of pain on the bottom of the heel and through the arch. It is a condition that presents with sharp heel or arch pain, worse upon rising in the morning and after getting up from extended rests. The pain worsens at the end of a long day on your feet. Pain can range from mild to severe.

The plantar fascia is an essential structure that supports the arch. It is a fibrous band of tissue that runs from the heel to the ball of the foot. Plantar fasciitis is the inflammation or degeneration of this tissue. It is a “repetitive strain injury” which means it occurs due to micro-trauma over hours or days. This trauma can be job related (standing or walking for long hours), sport related (overtraining) or from a sudden increase in activity (spring cleaning, extra walking during a vacation).

On X-ray, plantar fasciitis often is associated with a “heel spur”. A heel spur is an elongation of bone where the plantar fascia attaches to the heel bone. Heel spurs rarely cause pain because the pointed portion of a spur does not point downwards toward the ground, but rather forwards toward the toes. 

The real pain felt is from the plantar fasciitis condition itself, so treatment revolves around the treatment of the plantar fascia.

Risk Factors

• Footwear – Worn out footwear, flats, flip flops
  
  
• Weight – Being overweight puts extra stress on the plantar fascia
  
  
• Foot Type – Flat feet and high arched feet. A flat foot (overpronation) causes extra pull on the plantar fascia. High arched feet often have a tight plantar fascia which predisposes you to this condition
  
  
• Tight Calf Mucles – The calf muscle runs down the back of the leg and pulls upward on the heel. This directly increases tension through the plantar fascia
  
  
• Overuse – Doing more activity than normal for the days leading up to the development of pain is a common pattern. We see plantar fasciitis during/after vacations, spring cleaning or home renovations, where the individual is doing much more physical activity than usual.

Treatment
While there are several effective treatments for plantar fasciities, there is no “silver bullet” treatment. We suggest layering multiple treatments for best results.

• Rest – Rest is an essential step in recovery. You will need to decrease or stop activities that cause the pain. Activities such as running, walking (especially hills), stair climbing, jumping and squatting are particularly aggravating. Swimming and biking are good low impact alternatives. Many people are disappointed that they cannot participate in an activity they are passionate about during this time. Just remember that you will get back to that activity faster if you rest and heal now.
  
  
• Structured Running Shoes – Good cushion and support are vital. Your runners need to be fairly new and of high quality so there is plenty of cushion. The midsole (cushioned area) of your shoes wears out after 6-12 months depending on use. The best types of shoes for your foot will be recommended based on the biomechanical assessment performed at the clinic. Home footwear is equally as important during the healing process. Avoid flats, “skate shoes”, flip flops and other non-supportive footwear.
  
  
• Custom Orthotics or Off-The-Shelf Inserts – These products support the arch to reduce strain to the plantar fascia. The better the orthotic contours to the arch, the more it will reduce load to the plantar fascia. Average arch heights may do well with an off-the-shelf insert, but lower or higher arches will do best with a custom orthotic. At St. Catharines Foot Clinic, when we make custom orthotics, we mold the feet using a 3D scanner to achieve the best possible fit.
  
  
• Low Dye Taping – A chiropodist can apply tape in a specific manner to support the arch and reduce strain to the plantar fascia.
  
  
• Low Level Laser Therapy – This treatment offered in-clinic helps reduce pain, inflammation and speed up healing.
  
  
• Shockwave Therapy – Accelerates the healing process by speeding up cellular activity and enhancing blood flow to regenerate damaged tissue.
  
  
• Plantar Fasciits Night Splint – This product helps your plantar fascia heal in a lengthened position at night. It can also be helpful for morning pain. This product has been shown to be effective even for chronic cases.
  
  
• Rehabilitation Exercises – There are several rehabilitation exercises to help you progress through the various phases of healing. These exercises can be prescribed from your chiropodist.
  
  
• Medications – Anti-inflammatory medication can help manage pain and inflammation

Non-Resolving Cases

• Corticosteroid Injections – Performed by a chiropodist or orthopaedic surgeon. Corticosteroid injections to the plantar fascia are effective in managing pain. There is a reduced activity period of 2 weeks after a cortisone injection.
  
  
• Immobilization – Sometimes complete rest via immobilization is needed. 4 weeks in an air cast may facilitate this.
  
  
• Surgery – A partial plantar fascia or a proximal medial gastrocnemius release may be performed as a last option.

Prevention
To prevent recurrence, it is important to wear good quality shoes recommended by your chiropodist. Continue with basic calf stretching long term to reduce stress to the plantar fascia. When you travel, make sure you bring appropriate footwear for walking to avoid a flare up during vacation (very common).