Plantar fasciitis is inflammation of the plantar fascia – the thick band of tissue at the bottom of your foot that connects your heel bone to your toes and supports your arch. The condition is fairly common and one of the most frequent causes of heel pain. In fact, one of the classic symptoms is stabbing or burning heel pain, usually with your first steps in the morning. After you get moving, the pain often decreases, but it can flare up later in the day depending on your activity level.

By Patricia A Staszak, PT

Plantar fasciitis is inflammation of the plantar fascia – the thick band of tissue at the bottom of your foot that connects your heel bone to your toes and supports your arch. The condition is fairly common and one of the most frequent causes of heel pain. In fact, one of the classic symptoms is stabbing or burning heel pain, usually with your first steps in the morning. After you get moving, the pain often decreases, but it can flare up later in the day depending on your activity level.

The plantar fascia is a thick band of tissue at the bottom of your foot that connects your heel bone to your toes and supports your arch.

The plantar fascia is a thick band of tissue at the bottom of your foot that connects your heel bone to your toes and supports your arch.

In normal walking, our plantar fascia flattens as we pronate, or bear weight through the foot, and then it tightens to create an arch (supinates) as we push off the front of our foot to propel ourselves forward.  Problems arise if we pronate too early, too much or not enough.

Common symptoms of plantar fasciitis include :

  • Pain and tenderness when pressing on the heel or along the arch
  • Increased pain first thing in the morning, which then improves but gets sore and achy towards the end of the day
  • Pain with initial steps after a period of inactivity.
  • Pain during and after activity

While developing clinical guidelines for treatment of plantar fasciitis for the American Physical Therapy Association, Thomas McPoil and his team performed a comprehensive review of the literature.  They found the predisposing factors to developing plantar fasciitis include :

  • Limited ankle range of motion, particularly decreased ability to flex the toes up toward the shins.
  • High body mass index, especially recent weight gain – including pregnancy weight
  • Sudden increase in activity levels

Other factors that might contribute include :

  • Foot arch problems (both flat feet and high arches)
  • Tight calf muscle and/or Achilles tendon (the tendon connecting the calf muscles to the heel)

It's no surprise that plantar fasciitis is common in long-distance runners and those who run on hard or uneven surfaces, or downhill. In addition, wearing shoes with inadequate support can increase the risk of plantar fasciitis.

While the condition can be debilitating, the good news is non-surgical treatment can be highly successful. Treatment that McPoil's team found to be effective for plantar fasciitis included:
Activity limitation as needed (also known as rest!)

  • Calf stretching to increase ankle mobility
  • Short-term use of over-the-counter orthotic devices
  • Low dye taping – a taping technique to support the plantar fascia
  • Manual therapy to improve ankle and foot mobility
  • Modalities like ultrasound to improve healing of plantar fascia
  • Night splints (usually only considered if symptoms have been going on more than six months)

In my experience, effective treatment of plantar fasciitis requires a comprehensive approach using a combination of the above treatment techniques.  At Andersonville Physical Therapy, our first step is to work with you to figure out what's causing the problem – whether it's the type of activity you're doing, your shoes, gait issues or even muscles tightness elsewhere in your body. Then we can work on a short-term solution to better support your arch and to get your pain under control. 

Short-term steps might include suggestions for your footwear, an over-the-counter shoe insert and then adding additional support to it as necessary, or taping your foot to take the pressure off your plantar fascia.  If necessary, we can check out all your shoes and suggest better options.  Night splints and custom foot orthotics may also be considered.  However, it's interesting to note that custom foot orthotics have not been found to be effective in the long term management of plantar fasciitis.

In-office treatments to help reverse the condition can include hands-on manual therapy to improve the mobility of the joints and soft tissue of your foot and ankle.  Ultrasound and icing can also help manage your pain.  And of course, we'll give you homework — exercises to work on at home!  For treatment to work, it's very important to improve your ankle mobility, so we almost always give calf stretching exercises.  Foot and lower body strengthening are often also helpful.  And, because everything is connected, we'll screen your hips and core muscles for weakness and tightness patterns that may contribute to your problem.  We'll even evaluate how you move – specifically how you walk — and give suggestions to improve your gait. 

Plantar fasciitis is a challenging problem, but it's much more manageable when all available treatment options are utilized, movement patterns are analyzed and you're well informed about how to manage your symptoms.  At APT, we take a comprehensive approach to treat your foot pain. And we always welcome questions and communication so you feel like a partner in the process — so you can understand why you're having pain and what you can do to help it heal.

If you think you have plantar fasciitis, or you simply have questions about how to get started with physical therapy, give us a call at (773) 907-3599 or email andersonvillept@gmail.com

We'll be happy to talk with you about it and even set up a free evaluation session for you.

Works Cited

Fasciitis. Digital image. The Mayo Clinic. Mayo Clinic, 04 Feb. 2009. Web. 30 Oct. 2012. <http://www.mayoclinic.com/images/image_popup/r7_fasciitis.jpg>.

Ma, C. Benjamin, MD. Plantar Fasciitis. Ed. Linda J. Vorick, MD. U.S. National Library of Medicine, 01 Mar. 2012. Web. 30 Oct. 2012. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004438/>.

McPoil, Thomas G., PT, PhD, Robroy L. Martin, PT, PhD, Mark W. Cornwall, PT, PhD, Diane K. Wukich, MD, James J. Irrgang, PT, PhD, and Joseph J. Godges, DPT. "Heel Pain – Plantar Fasciitis: Clinical Practice Guidelines Linked to the International Classification of Function, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association." Journal of Orthopaedic Sports Physical Therapy 38.4 (2008): A1-A18. Print.