Plantar Fasciitis

Plantar Fasciitis

This week SportsPlus will be discussing plantar fasciitis.  The plantar fascia is a thick ligament that is located on the bottom of the foot.  The plantar fascia originates  from the calcaneous (heel bone) and extends to the toes.  Plantar fasciitis (acute phase) or plantar fasciosis (chronic phase) are the terms used to describe pain at the bottom of the foot when damage has occurred to this ligament.  This is usually caused by an overuse injury such as a new running program that produces repetitive microtears, most commonly at its origin of attachment on the inner aspect of the heel bone.

Symptoms of Plantar Fasciitis

The most common symptom of plantar fasciitis is a gradual onset of pain on the bottom of the foot at the heel bone that is worse when initially standing.  This is termed “first step pain” which is usually more prominent following  prolonged periods of sitting or lying down.  This is due to a rapid stretching of the plantar fascia after prolonged periods of fascial shortening.  Pain may be described as a sharp tearing sensation that diminishes after a few minutes of standing or may be expressed as a bruised heel with no visible discoloration.  Patients tend to notice an immediate reduction of pain upon sitting or relaxing the plantar fascia ligament.

Contributing Factors

Plantar fasciitis is typically seen in patients who start a new activity program, or experience excessive periods of standing.  Individuals who start a new long distance walking, hiking or running program are particularly susceptible to this condition.  Excessively tight hamstrings and calf muscles along with poor fitting shoes or flat feet may also contribute to plantar fasciitis.

Questions to ask yourself when considering plantar fasciitis: Do my signs and symptoms correlate with the onset of a new exercise program?  Did my heel pain have a gradual onset over several weeks/months?  Sudden heel pain following a traumatic event suggests an acute injury.  Is there any recent change in career or daily activities that require me to stand on my feet for prolonged periods of time?  Have I noticed any recent gain in body weight?  Is there excessive heel wear on the inner aspect of my shoes?

Treatment

In most cases, the treatment of plantar fasciitis can be managed by using a conservative approach.  First, your physician needs to find the root cause of your injury.  Once the root cause of your condition has been identified, an appropriate treatment plan can be implemented.  Most conservative treatment plans may include some or all of the following:  rest, ice, exercise/rehabilitation program, activity modification, self myofascial release such as foam rolling, instrument assisted soft tissue mobilization such as Graston, myofascial release technique such as ART and joint manipulation.  If your condition doesn’t resolve or diminish within two to three weeks of conservative management a more aggressive form of treatment should be considered.  This would include an orthopedic consult to discuss corticosteroid injections or a release of the plantar fascia itself.

Self myofascial release using a golf ball

Starting Position Movement
Begin seated, barefoot, feet on floor. Place golf ball or similar utility underneath foot.
Slowly roll back and forth, massaging plantar surface of foot as tolerated, for a duration of 1 to 2 minutes. Maintain consistent pressure with golf ball. If a painful area is found, stop rolling and REST on the area for 10 seconds as tolerated, then continue. Rest and repeat for prescribed repetitions and sets. Alternate sides as directed.

If you think you may be experiencing symptoms of plantar fasciitis you should contact SportsPlus or your local healthcare provider for an appointment so that you can receive a correct diagnosis and treatment plan.

Dr. Zugschwerdt is a chiropractic physician at SportsPlus in Pleasanton, CA

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