Plantar fasciitis is one of the most common musculoskeletal problems in the foot. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, which runs across the bottom of your foot — connecting your heel bone to your toes.  The most affected area of the plantar fascia is at the heel where it connects to the calcaneus.  
The plantar fascia acts as a shock absorber while you walk.  After your heel strikes down the plantar fascia stretches to absorb the forces produced by your foot hitting the ground.

Generally people that have plantar fasciitis present with a sharp pain in the heel during the first few steps taken in the morning or after sitting for a long period of time.  After walking a few steps the pain will usually ease as the tissue stretches out.  Tenderness will be felt on the bottom inside part of the heel of the foot.

So how does plantar fasciitis become a problem?  When the plantar fascia is continuously over stretched or a long term forceful stretch is put on the tissue several microtears will occur.  The tears will gradually build on one another and cause significant irritation.  The average person with plantar fasciitis can be overweight, have a job that requires a lot standing, may have excessive pronation, limited dorsiflexion, or may have recently started a new exercise program.   In athletes, changes in a regular routine can cause the fascia to become irritated, such as increasing running mileage, adding hills or running on a crowned road.

Physical Therapists use evidence based practice and an expertise in biomechanics to treat plantar fasciitis  Treatment can include stretching, soft tissue mobilization, joint mobilization, taping, ultrasound, dry needling, strengthening exercises and orthotics.  In acute cases iontophoresis can be used to deliver an anti-inflammatory medication to the immediate area.  The goal of treatment is to reduce pressure on the tissue that is being aggravated so that healing can occur.  It is important to find the contributing factor to the pain so that future occurrences can be avoided.

The most effective treatment that can be done at home is stretching.  The calf, made up of the gastrocnemius, soleus, and plantaris muscles, are generally tight in the patient with plantar fasciitis.  A tight calf muscle can limit dorsiflexion therefore increasing pressure on the forefoot and subsequently the plantar fascia.  In order to stretch this muscle you can stand and face a wall with your arms on it for support, place your painful foot back behind you and bend the front knee until a gentle stretch is felt on the back of the lower leg.  Make sure you keep your heel down and pressure on the outside of the back foot.  Hold for 30 seconds and repeat 3 times per session at least 3 times per day.  Now, repeat this same stretch, but bend the back leg at least 30 degrees.  This will now stretch your soleus muscle.  This stretching sequence is pivotal to preventing and treating plantar fasciitis.

The earlier that you see your doctor when symptoms become apparent the easier it will be to treat.  You can always ask your local physical therapist the best way to avoid injury when beginning a new activity and for advice on shoe wear, exercise and stretching.

Douglas J. Emerson, PT, DPT, OCS, CMP