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Plantar Fascitis

Plantar Fascitis diagram

The plantar fascia is a multi-layered fibrous tissue that begins at your heel and runs longitudinally along the bottom of your foot and attaches at the base of your 5 toes. The role of the planar fascia is to protect the foot and support the arch. This allows the foot to be both an efficient shock absorber and a spring for acceleration during walking and running.

Plantar fasciitis occurs when the fascia becomes inflamed secondary to excessive overuse or stress to the tissue. A person with plantar fasciitis will complain of pain in their heel or arch in the morning when they first put weight on their food or pain after they have been sitting for a long time and then put weight through the foot with their initial step. Plantar fasciitis can occur in individuals with abnormal foot mechanics such as excessive pronation (flat arch). Similar to most soft tissue injuries, proper treatment should bring about a successful outcome. One aspect of treatment is limiting pronation. Pronation is a natural phase of walking and running. However, excessive pronation is a problem to the plantar fascia.

Everyone lands on the outside of the foot. When the foot is rolled outward, it is rigid and can take impact. After the foot hits the ground, it rolls inward and flattens the arch. This motion is known as pronation. Pronation allows the foot to become flexible and adapt to the ground.

Excessive pronation strains the plantar fascia in two ways. First, it creates an overstretching. Secondly, it forces the foot to work harder to push off because it is in an inefficient position. Hence, techniques that limit pronation (i.e. running sneakers, taping, arch supports or orthotics) may be important to the healing process.

Proper exercise does not only help to speed healing but it also allows you to stay in shape. Cross training techniques include biking, swimming, and stairmaster are not harmful to plantar fascia. Walking, running, and sports involving running will keep the plantar fascia injured.

Stretching should be helpful. Tight gastroc/soleus (calf) complex can also contribute to increased stress on the plantar fasciitis. Gentle, pain-free stretches keep the fiber flexible during the healing phase. This is important to promote proper recovery. However, stretches that induce pain and involve quick movements do more harm than good.

Since pain occurs after long periods of non weight-bearing, before standing move the foot in circles one to two minutes to increase blood flow to the tissue for warm up. After this, you should get up slowly and preferably do some stretching. As you walk, begin slowly and gradually to get to a normal speed.

Recommendations to reduce pain and stress on the plantar fascia include the following:

• Do not walk bare food and limit footwear with little or no arch support.

• Wear running sneakers or shoes with a cushioned heel and increased arch support at all times.

• Put your foot up and ice the arm for 5-20 minutes at night (and any other time you think you have overdone it) or freeze a bottle of water and roll it up and down your arch.

• Do proper pain-free stretches before and after workouts, before bed and any other time you want for your calf muscles. Hold for 30 seconds for 3 repetitions.

• Move the foot in continuous pain-free circles for 1-2 minutes before getting out of bed or getting up after prolonged sitting.

• When initiating walking start very slowly.

• Avoid running and prolonged walking. Continue to do cardiovascular activities such as; biking, swimming, Stairmaster, and Nordic track for your exercise as long as they do not increase pain.

• Avoid walking and prolonged standing on hard surfaces (concrete), soft, unsupported surfaces (sand), and uneven surfaces (rocky trails).

• If you must walk or run, try to have the slope of the road support your arch. (i.e. the leg that needs to be supported should be on the downhill side of the slope).

• Use a golf ball to roll along plantar fascia as a message 5-10 minutes several times a day. Message increases blood flow to an area, which helps healing and breaks up tissue adhesions that may restrict motion.

• If possible, get someone to show you how to properly tape the foot or try an arch support insertion.

• Night splints can be worn during sleep to keep the foot dorsiflexed, which allows the plantar fascia to rest in a neutral position. The plantar fascia during sleep usually stays in a shortened position. When we first get out of bed and put weight through our feet, the plantar fascia stretches out. If inflamed, pain will result. The type of splint can be determined by your MD or physical therapist.

If not addressed plantar fasciitis can become a chronic problem which significantly limits activity, therefore the earlier one gets the proper medical attention the faster the rate of return to activity.


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