Plantar Fasciitis

Plantar fasciitis is pain on the bottom of the foot and arch where the plantar fascia attaches to the heel bone. It usually comes from a recent increase in weightbearing activity through exercise or weight gain in nonathletic individuals. Pain is the worst after prolonged inactivity, with the first steps in the AM, and with excessive activity.

Diagnosis is typically found with a clinical examination including subjective history, palpation of the area, a positive Windlass test (pain with stretching the fascia) and ruling out other causes such as tarsal tunnel syndrome, heel fat pad syndrome and stress fractures.

Treatment must be comprehensive to treat the condition and all relevant impairments as symptoms tend to be persistent with an extended timecourse.

Self-massage and icing may be completed simultaneously by freezing a water bottle and rolling on the foot. Stretching should target the plantar fascia. Calf stretching and self-mobilizations to the ankle should be performed to reduce stress on the midfoot in the stance phase of gait. Strengthening should include foot intrinsics (small muscles of the foot), ankle and calf musculature. Rathleff suggests heavy, slow resistance training with heel raises with a towel under the toes. Glute muscles help control lower extremity mechanics and support the arch.

Arch support taping should be trialed as well as over-the-counter orthotics, night splints and a change to more supportive shoewear. (Asics, Hoka, etc) Laser treatment may help speed up healing.

With persistent problems, cortisone injection may be discussed with your physician. Activity modification and nutritional and weight loss counseling should be used to decrease the stress on the foot.

Patience is key in this condition as there will be ups and downs as you work to progress your activity levels. It may be a long process but symptoms do resolve so keep your head up!