Ontario Podiatric Medical Association


Plantar Fasciitis (Heel Spurs)

5/1/2007

What is Plantar Fasciitis?

Plantar Fasciitis is an inflammation of the plantar fascia of the foot. The plantar fascia is a ligamentous connective tissue band that spans the entire sole of the foot. (See image)  It takes origin from the heel bone (calcaneus).  Plantar fasciitis is an overuse injury causing heel pain which may radiate forward into the foot. Plantar fasciitis is also commonly referred to as "Heel spur" although they are not strictly the same. 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 occur (with repetitive pulling of the plantar fasia) on a foot with no symptoms at all and a painful heel can have no heel spur present.

A rupture to the plantar fascia, following trauma or injury, can sometimes occur at the origin of the arch ligament and result in inflammation and heel pain.

What are the symptoms of plantar fasciitis?

Heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.
Sometimes there may also be pain along the outside border of the heel. This may occur due to the 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.
Pain is usually worse first thing in the morning. After a few minutes it eases as the foot gets warmed up, but can get worse again during the day especially if walking a lot.

Who does plantar fasciitis commonly effect?

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

Common causes of 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 inflammation and thickening of the tendon. As the fascia thickens it loses flexibility and strength.

Some practiioners think you will see pronation by 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 abnormailities which should be assessed by a podiatrist / physiotherapist / biomechanist
 
Treatment for Plantar Fasciitis:

What can the athlete do for plantar fasciitis?

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 aggrevating the injury and increasing inflammation. However 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 which allows the inflammation to settle and healing to take place. Click here for step by step instructions with streaming video.
Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved.
Stretching the plantar fascia 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 becoming inflamed. Tightening of the plantar fascia happens in particular over night which is why pain is often worse in the morning. A plantar fasciitis night splint is an excellent product which is worn over night and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.
What a Sports Injury Professional can do:

Prescribe anti-inflammatory medication such as ibuprofen.
Prescribe orthotics. An orthotic insole can restore normal foot biomechanics and reduce overpronation which is a contributary factor for plantar fasciitis related heel pain.
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 aid stretching of the tissue. 
Use a corticosteroid injection - usually best combined with biomechanical correction with orthotics.
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. 
Shockwave Therapy (either high frequency or radial) is a treatment modality that is currently being employed to treat chronic presentations of this condition. Surgery, by means of minimal incision, endoscopic or traditional (open) technique is reserved for those recalcitrant cases where conservative measures have failed to provide symptomatic relief.

More information on plantar fasciitis including answers to the following questsions is available from your podiatrist:

  • How can I stretch the plantar fascia?
  • Which other stretches are important?
  • How are sports massage techniques applied?
  • How often should I stretch?
  • How often should massage be applied?
  • How is tape applied to the foot?
  • How should I return to full training?
  • How can I prevent plantar fasciitis recurring?
  • What treatment options best suit the nature of my complaint?

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