June 25, 2020
The Plantar fascia is a layer of tissue extending along the sole of the foot from the heel to the toes. It is composed of three segments that support the arch of the foot. Planter fasciitis is an overuse condition of the plantar fascia, where it is excessively and repetitively stretched and shortened, degenerating the fascia. This mechanical overuse explains why the incidence in runners is high, amounting to 10% of all running injuries.
Individuals with high or low arches are at increased risk of developing the condition. Low arches disturb the fascia as it attempts to maintain the foot’s arch and is therefore overstretched. With high arches, the foot is a rigid lever and therefore has reduced ability to adapt to the ground surface and absorb shock, placing strain on the heel area where the plantarfascia originates. Other risk factors include reduced ankle mobility and increased BMI. Tightness and weakness in calves, hamstrings and glutes also predispose athlete’s to plantar fasciitis.
How can you tell if it might be plantar fasciitis? Classically, you’ll feel pain on the inside of the heel and will be worse in the morning getting up or getting up after sustained periods of sitting. As it is a degenerative condition, it worsens over time without intervention and as the severity increases, this means that over time activity or even bearing your own body weight may aggravate symptoms.
What can you do to manage plantar fasciitis? The good news is that plantar fasciitis generally has a good prognosis, with symptoms usually completely resolving within 12 months of initial onset and often sooner. Pain management strategies will often be implemented in tandem with a long-term treatment plan. Plantar fascia stretching and self-massage with either a golfball/ frozen bottle of water can manage pain quite effectively. Silicone gel heel pads and taping of the sole of the foot can be very effective in reducing pain in the short term as well, creating a window of opportunity to engage in a rehabilitation program.
Long term management includes strengthening of the intrinsic foot muscles and the muscle surrounding foot and heel. Footwear will most likely be adapted to support the fascia and orthotics might be considered for the same reason. Generally, conservative management is enough to manage the condition, though 5-10% of patients presenting with plantar fasciitis will require surgical release. Pain limits people’s engagement in physical activity which contributes to the condition itself creating a disease cycle. The most important and empowering thing a runner with plantar fasciitis can do is start small with pain management and gradually return to their sport.