PLANTAR FASCIITIS
What is Plantar Fasciitis? Plantar fasciitis is a common overuse injury caused by repetitive strain to the plantar fascia. This is a common cause of foot pain in athletes and non-athletes. Similar to other overuse injuries, plantar fasciitis may cause acute or chronic pain. Plantar fasciitis accounts for 7% - 9% of all running injuries. Athletes active in other sports that require repetitive push-off motions, such as tennis, basketball, soccer, and gymnastics, are also vulnerable.
The plantar fascia forms an important secondary restraint in the foot, helping to maintain the medial longitudinal arch by tightening like a bowstring on the plantar surface. The plantar fascia acts as a shock-absorber for the foot when the foot lands on and pushes off the ground. During running, the force generated on the plantar fascia is four times greater than when walking and occurs 800 - 2,000 times per mile run.
What causes plantar fasciitis? Some factors which may cause plantar fasciitis include: excessive running time, increasing speed when not properly warmed up, running up hills, shoes that are old or worn, over pronation, pes planus (low arch), leg length discrepancy, poor strength and flexibility of achilles tendon, heel pad flattening, and aging.
What kind of pain is associated with plantar fasciitis? The classic history of plantar fasciitis is characterized by sudden onset of a sharp burning pain in the tissue around the heel. The pain is usually more severe when the athlete first arises; a tearing sensation may accompany the athlete's first few steps. During the initial stages of exercise, the symptoms are more severe, easing as exercise continues. The pain may eventually be felt in the arches of the mid foot causing it interfere with activities of daily living.
How do you manage plantar fasciitis? Acute uncomplicated cases may be successfully managed with conservative modalities. For proper management of both acute and chronic fasciitis, three area must be addressed: inflammation, inciting factors, and rehabilitation.
Inflammation. Rest and non-steroidal anti-inflammatory drugs may be used as first treatment. Rest involves continuing activities at reduced intensity or duration and avoiding actions that might worsen the pain such as prolonged walking, running, or jumping. Icing the painful area is also very important in reducing inflammation.
Inciting factors. Appropriate footwear for everyday activities and sport is very important for alleviating fasciitis and preventing other foot problems. A heel cushion may provide extra shock absorption during heel strike. Training adaptations may also be necessary. For example, runners whose overuse injury was brought on by excessive or accelerated mileage and hill running should reduce intensity and mileage.
Rehabilitation. Rehabilitation should begin as soon as inflammation and pain have begun to subside, which may vary from a few days to a few weeks. Stretching the achilles tendon and calf muscles is necessary to restore ankle range of motion. Strengthening the muscles of the foot and ankle are also necessary to prevent further complications and injuries.
In Closing. Plantar fasciitis is a common overuse injury which if treated correctly early, will not cause chronic pain and loss of exercise time. If stretching, warming up, and training correctly are a part of your exercise program then you should have a safe and injury free experience.
References
Mark E. Batt, MB, BChir,
Jeffrey L. Tanji, MD:
Management Options for Plantar Fasciitis
The Physician and Sportsmedicine,
June 1995 Vol. 23 Pages 76-86