Plantar Fasciitis (Heel Pain)

Plantar fasciitis is something  that many runner have experienced, possibly on a recurring basis.  What is it? Plantar fasciitis is usually an overuse injury caused by strain and inflammation of the thick fibrous tissue that connects from the bottom surface of the heel bone to the bottom of the toes.  The role of the plantar fascia includes: 1) holding the parts of the foot together (bones, nerves, muscles, tendons), 2) protecting the bottom of the foot from injury, and 3) helps support  the longitudinal arches of the foot.

When this tissue is injured and inflamed it creates heel pain and potentially arch pain in the foot.   Often people think it is caused by a bone spur, but research has found this is not the case.   With X-ray, bone spurs are seen in people with and without heel pain.  There are other causes of heel pain including stress fractures, fat pad contusions, nerve entrapments and lumbopelvic spine conditions.

The following is a list of contributing factors and possible causes of plantar fasciitis:

Tightness and /or weakness in muscles of the lower leg that attach a the foot
Gastroc/Soelus (usually tight)
Posterior Tibialis (usually weak)
Anterior Tibialis (can be weak or tight)
Peroneals (usually weak)
Weak foot intrinsics (small muscles in the foot)
Proximal weakness in the trunk and upper legs
Excessive pronation or supination
Improper footwear
Wearing high heels on a regular basis, which contributes to lower leg tightness
Repeated high direct impact (excessive heel strike with running )
Decreased dorsiflexion range of motion (old ankle sprains, tight calves, joint stiffness)
Asymmetrical weightbearing through lower extremities (are you balanced)

Symptoms may include:  pain in the bottom of the heel with weightbearing often worse first thing in the morning improving during the day; often painful with the first few steps after prolonged sitting; aggravated by walking/standing/running; eases with rest; often worse when barefoot; pain reproduced with direct palpation of the insertion point on the heel bone and with stretching toes up.

What can you do?  Wear supportive footwear; tape your arch; ice; massage plantar fascia and calf; relative rest; heel cup or night splint; calf stretching; ankle strengthening; foot strengthening; specific drills to decrease impactive forces; general lower extremity and trunk strengthening; get footwear checked and possibly orthotics.  If you are unsure about what to do or you are not seeing improvement you should seek treatment from a PT or consult your physician.

Kristi Moore, MSPT
For Alpine Physical Therapy


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