Plantar fascia is a thick band of tissue on the underside of the foot running from the front of the heel to the ball of the foot. This band of tissue is what creates the arch of the foot. The plantar fascia is separated into three different bands. One is positioned near the instep, the other in the centre of the foot, and the final band runs near the outer side of the foot. The plantar fascia has an important role in maintaining a stable foot and rigid when we push off during walking and running and as such its function relates closely to that of the calf and Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). When the fascia is overstretched or overused, it can become inflamed. When the fascia is inflamed, it can be painful and make walking more difficult.
Risk factors for Plantar Fasciitis include:
Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the plantar fascia.
Obesity, this will put extra strain on your heel.
Repetitive loading on the feet from lots of walking, standing, running, especially running downhill or on uneven surfaces. The condition is sometimes called ‘policeman’s heel’.
Recent weight gain.
Tight Achilles tendon (the tendon connecting the calf muscles to the heel).
Shoes with poor arch support or poor cushioning. (see footwear advise).
Affects active men ages 40 – 70.
Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel bone. Often there is no apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or ‘spur’ coming from the heel bone (calcaneus). Many people have a bony spur of the heel bone but not everyone with this gets plantar fasciitis.
Symptoms of plantar fasciitis
Plantar fasciitis often leads to point tenderness on the inside portion of the heel where the heel and arch meet. This painful tenderness especially first thing in the in the morning when you first place your heel on the ground and are struck by a sharp pain. This is because your ligaments will have cooled down during rest, and cool ligaments do not stretch well. Pain may lessen after a few steps, but it comes back after rest or with prolonged movement.
Treatment of plantar fasciitis
The podiatrist will assess your foot (see biomechanical assessment) and identify the cause of the plantar fascia pain. As plantar fasciitis is predominantly caused by over pronation of the feet, a treatment plan to control this motion will be implemented. If left untreated, plantar fasciitis can become a chronic and debilitating ailment that may eventually require cortisone injections or surgery. Physiotherapy is often appropriate and involves calf stretching exercises, soft tissue massage to tight calf muscles, and various exercises to resolve any other movement dysfunctions that might be present. In the more chronic or persistent cases injection therapy is often effective.