The plantar fascia is a thick, fibrous band of connective tissue, running along the sole from the heel to the ball of the foot. Overuse or overstretching this fascia can cause very small tears in the tissue, and consequently, inflammation and irritation of the plantar fascia. Due to this damage the plantar fascia pulls on the bone where it attaches into the calcaneus (heel). This explains why most people with plantar fasciitis will describe pain primarily in the heel.
Causes of Injury
Plantar fasciitis is caused by inflammation and degeneration due to excessive stress or strain being placed on the plantar fascia. This can be due to a traumatic injury to the foot (acute) or biomechanical abnormalities, however sometimes the specific cause can be unknown.
There are a number of factors that could increase a person’s risk of developing plantar fasciitis. These include:
- Tightness in the calf muscles or ankle stiffness
- Abnormal lower limb biomechanics, such as over pronation of the feet, flat feet, high arches or significant differences in leg length
- Poor footwear, providing inadequate arch support or have stiff soles
- Sports involving a lot of running, jumping, dancing or aerobics.
- Long periods of standing or walking on a regular basis
- Middle-aged or older
- Sex (increased incidence in women)
- Pain on the underside of the heel or arch of the foot
- Heel pain that tends to be worse with the first few steps in the morning or after rest
- Pain aggravated by continuous activity, such as running, toe walking or climbing stairs or with periods of prolonged standing or walking
- Stretching of the plantar fascia may cause pain
- Tenderness when touching the heel and arch of the foot
Initially treatment is aimed at reducing pain and inflammation and correcting biomechanics to offload the plantar fascia. This can be best achieved by:
- Relative rest from aggravating activities
- Icing the affected area
- Arch supports, orthotics or heel pads
- Taping to support the plantar fascia and allow rest
- Achilles and calf stretches
- Gentle stretching of the plantar fascia
- Appropriate anti-inflammatory medication as prescribed by a doctor or pharmacist
- Physiotherapy, including massage, ultrasound, a thorough assessment to identify contributing factors and development of an exercise program to correct these
- Education and advice regarding training/exercise, warming up and cooling down, weight loss and appropriate footwear
Return to Sport/Activity
Plantar fasciitis, in most cases, will improve completely with conservative treatment. This may, however, take a number of months and persistence with exercises and self-management is important. Use of orthotics or heel pads after the pain has resolved will likely be continued to prevent recurrence.
If the condition is not improving with appropriate treatment over a prolonged period, a cortisone injection may be given. This is most effective if combined with biomechanical corrections using orthotics. Surgery may also be considered after a period of ~12 months of ongoing pain and is aimed at reducing tension in the tight fascia. Following this, physiotherapy will be required to develop a graduated exercise/stretching program, including gradual return to activity after a period of three to four months.