Column: Sports Health: By Matt Borowski
Plantar fasciitis is a condition that many people have heard of, but not everyone completely understands. The plantar fascia is a flat band of tissue (ligament) that connects the calcaneus (heel bone) to the toes on the plantar (bottom) side of the feet. The term plantar fasciitis refers to when the plantar fascia gets irritated (inflamed), which may result in weakness and pain. Someone suffering from plantar fasciitis will typically have pain around the heel or on the bottom of the foot, especially while standing or walking.
Plantar fasciitis will often times develop over an extended amount of time (chronic), and the reason is often unidentifiable. However, there are a few risk factors that may predispose a person to plantar fasciitis:
• High arch in feet or flat feet
• Inward rotation or twist (pronation) of the foot while walking/running
• Excess body weight
• Tight calf muscles
• Activities with repetitive impact (running/sports)
• New or increased activity
• Footwear with poor cushioning and structural support (high heels/sandals/flats)
• Extended periods of standing
• Age (most common between 40-70 years old)
• Training on hard terrain
Initially, treatment of the plantar fascia is a conservative approach. Resting the feet and avoiding bothersome activities will allow the tears of the plantar fascia to heal. Rolling feet on a frozen water bottle or icing the feet for around twenty minutes multiple times a day may aid in minimizing inflammation. Over the counter ibuprofen (Advil) or naproxen (Aleve) medications can also be taken to minimize pain and inflammation. Reducing the tightness of the Achilles tendon by stretching the calf muscles is also advised, and may relieve some pain. The plantar fascia can also be stretched by gentling pulling the toes into extension on the affected foot with a towel or by hand toward the ankle. Night splints can also help reduce plantar fascia tightness by preventing the foot from pointing downward while sleeping. Changes in footwear should also be considered not only to treat plantar fasciitis, but also to prevent it from occurring. Shoes with thick soles and extra cushioning can help reduce pain while standing or walking. Shoe inserts (orthotics) and heel cups are also a great way to support the arch and heel.
If the at home treatment doesn’t resolve the plantar fasciitis, a cortisone injection with physical therapy is typically the next step of treatment. Cortisone is a powerful anti-inflammatory steroid that is injected directly into the plantar fascia to reduce the pain and inflammation. If physical therapy and steroid injection treatments are unsuccessful, then surgical options may be considered. Two well-known procedures to treat plantar fasciitis are gastrocnemius recession and plantar fascia release. Gastrocnemius recession involves lengthening some of the calf muscles to increase ankle range of motion, which can reduce tension at the heel. Plantar fascia release is a procedure that involves partially cutting the plantar fascia ligament to relieve tension and possibility removing any large bone spurs.
Do you have a question regarding sports medicine that you would like to see addressed in this space in the future? Send your questions to SportsMed@lrhc.org and it may be featured in an upcoming article.
Matt Borowski is an athletic trainer for Lake Region Healthcare