Spring has finally arrived don't be hobbled by plantar fasciitis

It has been a long winter in southern Ontario. Most people have limited their walking outside due to snow and ice on sidewalks and roads. The good news is most of the snow and ice has melted from the sidewalks making it safer to walk without slipping. The bad news is that first spring walk or run might lead to heel pain.

Plantar fasciitis usually comes on gradually, but can occur suddenly and be severe. It can affect both feet, but often occurs in only one foot at a time. 

Plantar fasciitis is the most common cause of heel pain. The pain is caused by inflammation of the tissue along the bottom of your foot that connects your heel bone to your toes. Plantar fasciitis causes stabbing or burning pain that is usually worse in the morning because the fascia tightens overnight. The pain usually decreases as your foot limbers up, but it may return after standing for a long time or after getting up from a seated position. If plantar fasciitis is not dealt with quickly it can become chronic. The pain of plantar fasciitis can be dealt with by using conservative therapies however in a small number of cases surgical intervention may be indicated.

Symptoms include:

• Sharp pain in the inside part of the bottom of your heels.

• Heel pain that tends to be worse with the first few steps after awakening, climbing stairs or standing on your tiptoes.

• Heel pain after standing long periods or after getting up from sitting.

• Heel pain after, not during, exercise.

• Mild swelling in your heel.

Normally, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot especially when you heel is lifting off the ground. The plantar fascia helps the foot from bending. If the foot structure is unstable, the plantar fascia can stretch or pull away from the heel bone. Small tears can be created in the fascia if tension on that bowstring becomes too great. Repeated stretching and tearing can cause the fascia to become irritated or inflamed and thickened.

Causes of the condition include:

• Physical activity overload. It’s common in long-distance runners. Jogging, walking or stair climbing can also place too much stress on the heel bone and the soft tissue attached to it, especially when starting an aggressive exercise program. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

• Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal walking pattern, can adversely affect the way the weight is distributed when you’re on your feet, putting added stress on the plantar fascia. 

•  Improper shoes. Thin-soled, loose shoes or ones which lack arch support or the ability to absorb shock don’t protect your feet. If you’re a wearer of high-heeled shoes, your Achilles tendon – which is attached to your heel – can contract and shorten, causing strain on the tissue around your heel.

• Arthritis. Some types cause inflammation in the tendons in the bottom of your foot, leading to fasciitis.

• Diabetes. We don’t know why, but plantar fasciitis occurs more often in diabetics.

Developing plantar fasciitis is more likely if you are:

• Active in sports. This may put a lot of stress on your heel bone and attached tissue. Included are running, dancing and jumping.

•  High or low arched feet. Flat feet may have poor shock absorption, increasing the stretch and strain on the plantar fascia. High arched feet have tighter plantar fascia, which also leads to poor shock absorption.

•  Middle-aged or older. Heel pain tends to be more common with aging, because the arch of your foot tends to sag more, putting stress on the plantar fascia.

•  Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.

• Pregnant. With this comes weight gain and swelling that can cause you body’s ligaments, including your foot ligaments, to relax. Mechanical problems and inflammatory conditions can result.

•  Occupation. Certain occupations demand this, such as teaching, working in a factory, or being a waitress. Damaging your plantar fascia is more common in these cases.

• Wearing shoes with poor support or stiff soles. Using a lot of poorly designed pumps, loafers, and boots can lead to plantar problems.

Over time the plantar fascia can become thickened. This leads to a chronic pain situation which is more difficult to treat. Chronic pain in you heel will unfortunately change the way you walk and will put more stress on other joints in your body such as your ankles, knees and lower back. Chronic pain will limit your regular activities or your ability to work.

For most people, the condition improves within a year of starting conservative treatment. The longer you delay treatment the longer it will take to heal your plantar fasciitis.

Non-surgical treatments that may assist healing include:

• Footwear.   Footwear should have firm heel counters and a stiff midsole. The shoe should not be able to be twisted easily.  The area across the ball of the foot should be flexible to allow for the toes to bend.  If athletic footwear is required the type of athletic footwear should be sport specific. If a running shoe is required, the right class of running shoe should be determined. For example, do you require a cushioning running shoe, mild or moderate stability running shoe or a motion control running shoe?

•  Night splints. This is a splint fitted to your calf and foot while you sleep, holding the plantar fascia and Achilles tendon in a lengthened position overnight so they can be stretched more effectively.

•  Taping. Application of athletic taping to support the bottom of your foot. Foot orthotics are indicated if this arch taping is successful

• Foot orthotics. These are over the counter or custom orthopedic devices that fit inside your shoes to help stabilize the foot bones. Foot orthotics can help distribute pressure more evenly underneath the plantar surfaces of both feet

• Walking cast. A removable walking cast can be used in chronic conditions

• Physical therapy.

1. Exercise to stretch the calf muscles and to strengthen lower leg and foot muscles and increase range of motion of certain foot joints.
2. Ice massage to the area of the origin of the plantar fascia
3. Low level laser therapy to reduce pain and initiate healing
4. Mobilisations and manipulations of the foot joints.

When conservative treatments aren’t effective these treatments can be considered:

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•  Corticosteroids injections. One or two injections of this kind of medication, such as Prednisone, into the region of the plantar fascia attachment at the heel, provides temporary relief. Multiple injections should be avoided because they can weaken your plantar fascia and even cause it to rupture, as well as shrink the fat pad covering the heel bone.

• Extracorporeal shock wave therapy. Sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic cases unresponsive to conservative treatments. This is not used for children, pregnant women or people with a history of bleeding problems.

• Plantar fasciotomy surgery. A small number of suffers need surgery to detach a plantar fascia from the heel bone (plantar fasciotomy). This is an option only when the pain is severe and all else fails. A side effect is weakening of the arch in your foot.

One of the analogies, I like using to explain plantar fasciitis is the flooded basement analogy.  The water on the basement floor is like the symptoms of plantar fasciitis. You can get rid of the water but, the crack in the basement wall allowing water into the basement is the cause. If you don’t address the crack in the wall the water will come back into your basement during the next rainfall.

If you don’t address the cause of your plantar fasciitis your symptoms will come back.  

In summary, your heel pain will reoccur if you don’t address your: faulty foot mechanics, weak or tight foot and lower leg muscles, physical activity levels, footwear, arthritis or diabetes.