Many athletes, particularly runners, have suffered from heel pain due to plantar fasciitis. This article summarizes cause, treatment and prevention of plantar fasciitis.
What is Plantar Fasciitis?
Plantar Fasciitis is inflammation of the tough connective tissue layer (the plantar fascia) that supports the arch of the foot. The plantar fascia extends along the bottom of the foot, and attaches to the heel (calcaneus). In plantar fasciitis there is inflammation, and possibly tearing of this connective tissue. The heel attachment of the plantar fascia is the most commonly affected site in the disorder. Symptoms of plantar fasciitis include sharp heel pain, particularly first thing in the morning. The pain may decrease as the body warms up, and may even disappear for short periods of time. By the end of the day, the patient may experience a dull ache in the heel area, particularly after standing for long periods.
What are the Causes of Plantar Fasciitis?
There are both extrinsic and intrinsic causes of plantar fasciitis. Extrinsic causes are usually related to exercise.
Extrinsic causes include:
- Increased intensity of training in runners – this includes increasing training distance too rapidly, or addition of intense speed work.
- Training on a hard surface – this is more common in runners who train indoors.
- Poor training technique.
Intrinsic causes refer to physical characteristics of the athlete that predispose him or her to injury.
Intrinsic causes include:
- Structural risk factors – flat feet (pes planus), leg length discrepancy, overpronation/underpronation, tightness of the calf muscles.
How is Plantar Fasciitis Diagnosed?
Generally, plantar fasciitis is diagnosed based on the history and symptoms of the patient, and is confirmed on physical exam. Imaging studies, such as x-rays and MRI scans have a limited role. In some cases, an x-ray may be ordered to rule out bone pathology as the cause of heel pain. In severe cases, MRI scans are useful to evaluate for tears of the plantar fascia, which may require surgery.
How is Plantar Fasciitis Treated?
Initially, plantar fasciitis is treated conservatively, like most soft tissue injuries. The patient is advised to follow the “RICE” (rest, ice, compression, elevation) protocol. Generally abstaining from the activities that resulted in pain will resolve the condition with time. Anti-inflammatory medications (ibuprofen, naproxen) may be used to speed healing and decrease pain.
Physical therapy is often prescribed, with exercises to include heel and calf stretching and strengthening exercises.
How is Plantar Fasciitis Prevented?
Attention must be paid to training intensity and techniques in order to prevent plantar fasciitis. Exercise loads should be increase gradually, rather than suddenly, and adequate rest should follow intense workouts. Also, use of proper equipment, particularly running shoes, is essential. Shoes should be replaced frequently (depending on weekly mileage), to insure proper cushioning. Runners with foot problems such as flat feet should consider seeing a foot care specialist for orthotics to prevent injury. Additionally, so-called “motion-controlled” shoes are a better choice for preventing injury in flat-footed runners.
