Friday, November 17, 2006

Plantar Fasciitis

by Randall J. Brown, MHS, PT

A runner comes to me and says that a couple weeks ago he developed pain on the bottom of his heel which won't go away. It's worse in the morning, feels a little better if he heats it up or jogs on it, and it's especially painful when I poke it with my thumb. He may have arguably the most common foot injury that plagues runners: plantar fasciitis. Plantar fasciitis is a very common injury that can put a runner out of commission for a long time if it's not treated early.

Plantar fasciitis is the inflammation of the plantar fascia at its attachment to the calcaneus (heel bone). Often it is accompanied by calf (heel cord) tightness, which causes an overload at the plantar fascia's attachment, during weight-bearing activities. This leads to micro tears and local inflammation in the plantar fascia. The sometimes-excruciating pain is from the stretching of inflamed tissue.

What else can the heel pain be from?

I suppose it goes without saying, but I'll say it anyway: one should first rule out obvious things like a splinter, plantar wart or blister. There are several other items that we call differential diagnoses (other problems that may trick you into thinking that you have plantar fasciitis when you really don't). These include achilles tendinitis, a fat pad contusion (bruise on the bottom of your heel), plantar arch strain, tarsal tunnel syndrome, or a dreaded stress fracture of the calcaneus.

Maybe you have a heel spur?

A heel spur is a calcification that may occur at the attachment of the plantar fascia to the calcaneus. Sometimes it's called a traction spur. Although the heel spur may show up on an x-ray of the heel of a runner with chronic plantar fasciitis, the spur itself is rarely the cause of the pain. The pain again, is caused by a pull on the inflamed plantar fascia.


Okay, so even though you may not be able to pronounce it, you accept that you have plantar fasciitis. What do you do about it? Luckily, there are many things you can do for it. The most conservative means of treating plantar fasciitis is with relative rest (cross train for awhile), ice the painful area, wear supportive footwear though out the day, stretch your calf muscles, and maybe take some anti-inflammatory medications. Other appropriate treatment includes cross friction massage to the area, strengthening your foot flexors, and perhaps using a small heel lift to reduce the strain on your heel from the achilles tendon and plantar fascia. Plantar fasciitis isn't one of those injuries you can train through without treating. You may need a professional to assess your foot and biomechanics. Physical therapists often use modalities such as phonophoresis or iontophoresis to help reduce the inflammation associated with this injury. Find someone who knows how to do Low Dye taping for your arch, which decreases your pronation. Some people need custom orthotics to correct biomechanical excesses. Many tough cases respond to a resting night splint or the less flattering short leg walking cast. Less conservative means of treatment includes the dreaded corticosteroid injection to the area (this involves a needle).In a small number of cases for people with intractable pain that does not respond to anything else, there is the very dreaded partial plantar fasciectomy (which involves a scalpel).

For more information about plantar fasciitis, please contact a physical therapist, podiatrist, or an orthopedist. With this and all injuries that you deem significant, I recommend that you see a physician for an accurate diagnosis.