Pain on the Bottom of Your Foot: Plantar Fasciitis

Fascia is connective tissue that runs throughout the entire body, connecting, surrounding, and supporting muscles, tendons, and nerves. It also separates the skin and subcutaneous fat (body fat that’s just under the skin) from the underlying muscles and other soft tissues. Like all other connective tissue in the body, the fascia can develop adhesions, become inflamed, tear, or be subjected to some other kind of injury. Due to its interconnected nature, movement restrictions, tightness, or pain in the fascia in one region of the body can affect other parts of the body.

One place in the body that is particularly susceptible to irritation, chronic inflammation, dysfunction, and pain is the plantar fascia, located on the soles of the feet. Plantar fascia runs from the bottom of the heel to the ball of the foot. This fascia supports the foot’s main arch and stabilizes the foot during pushing-off (like during running and jumping). When this tissue becomes inflamed, the condition is called plantar fasciitis.

Causes

Plantar fasciitis is typically caused by excessive repetition of push-off types of activities. These activities place a great deal of tension on the plantar fascia, which is naturally tightened when the toes (especially the big toe) are dorsiflexed (the toe is bent back toward the shin, like the position the foot is in during a sprinter’s starting stance). The tension applied to the plantar fascia is increased when this position is done while weight-bearing (standing in rélevé/demi-pointe) or with high force (jumping, sprinting). During running, the tension placed on the plantar fascia is close to twice the runner’s body weight.

Other things that will increase the tension on the plantar fascia, worsen symptoms of plantar fasciitis, and heighten the likelihood of developing the condition are:

• Standing for extended periods of time, especially in unsupportive shoes or while barefoot
• Abnormal arch height:
• High, stiff arches (people with a rigid, cavus foot): the foot has too little motion to absorb ground reaction forces properly
  
• “flat feet”/low arches or people with hyperpronation: the foot moves too much, making the plantar fascia “work” harder to stabilize the foot during weight-bearing activities
• Running in old or “dead” shoes with insufficient arch support and stability
• Running with too long a stride for your body and leg length
• Running on excessively soft surfaces, especially at the initiation of training on these surfaces (this can include sand and old field-turf fields)
• Tight Achilles tendons and calf muscle complexes
• Sudden increases in intensity or duration of activities
• Significant weight gain (usually most influential at the initiation or resumption of activity)
• Improper landing or running mechanics

How to Recognize Plantar Fasciitis

The most distinguishing characteristic of plantar fasciitis is pain on the bottom of the foot when first standing in the morning.

Other signs and symptoms include:

• Pain throughout the bottom or arch of the foot that is most intense near the heel, on the arch side of the sole of the foot
• Tenderness on the bottom of the foot, just in front of the heel
• Increase in pain upon standing up after an extended period of non-weight-bearing
• Increased pain with dorsiflexion of the toes (bending the toes back toward the shin)
• Increased sensation of tightness or pain in the sole of the foot while stretching the calf-Achilles complex

Self-Treatment

Management of plantar fasciitis, especially if you are still participating in some sort of activity, will take an extended period of time, possibly up to 3-4 months. Wearing supportive footwear and orthotics (if appropriate) whenever possible can facilitate recovery and shorten the amount of treatment time needed to completely resolve all plantar fasciitis symptoms. If plantar fasciitis is brought on by cross-training activities, switching to a different, non-aggravating cross-training routine will improve symptoms.

Many of the most effective forms of treatment for plantar fascia are aggressive and not very pleasant to endure. Additionally, most of them are not to be performed daily, but rather every other day or every third day. The aggressive nature of these treatments is necessary due to the fact that the plantar fascia is so thick, dense, and fibrous that it does not respond very well to less aggressive treatments like light massage or traditional static stretching. However, these less aggressive treatments can still be applied to related tissues to reduce symptoms, facilitate healing and recovery, and enhance the effectiveness of other treatments.

Manual Treatments:

• Tennis ball or racquet ball massage (place the ball on the ground and roll your foot over the ball)
• Frozen water bottle roll (same technique as the tennis/racquet ball, but with the effects of cold therapy)
• Ice massage
• Brief, targeted cross-friction massage, focused near the heel (only if your pain allows this) Remember to start and finish your treatment with a light massage.

Additional Treatments:

• Stretch the calf/Achilles frequently (at least 3 times per day, stretching both calf muscles)
• Anti-inflammatory medicines can help, but avoid taking them in high doses if you are still participating in jumping, sprinting, or other explosive push-off activities with intense plantar fascia pain. Always follow physician directions or label instructions.
• Rest! Rest while wearing an orthotic, night splint, or short leg boot can help keep the fascia from shortening during long periods of inactivity (this shortening is what causes the sharp increase in pain upon rising again). If you are not able to wear any of these devices, do not let the toes curl or let your foot rest in a pointed position (plantar flexed position) while you are resting.

When to go to the Doctor

Correctly managing plantar fasciitis is critical, as improperly managed or completely untreated plantar fasciitis can lead to a partial or complete tear of the fascia. Untreated or mismanaged plantar fasciitis can also lead to the development of bone tissue inside the fascia at the heel (called a heel spur). Fascial tears and heel spurs require surgical treatment for complete resolution.

Seek a medical professional’s guidance and expertise if:

• You have excessive pain that interferes with your daily life (you can’t walk without a limp)
• Rest and/or other treatments do not reduce your symptoms
• You would like custom orthotics (as opposed to over the counter or semi-custom orthotics available at drug stores and specialty shoe stores)