Plantar fasciitis is an inflammation of the plantar fascia, the thick fibrous tissue that runs the length of the long arch on the sole of the foot. The longer the inflammation lasts, the greater the possibility a bone spur will develop at the point where the plantar fascia attaches to the heel bone.When placed under too much stress, the fascia ligaments stretch little, if at all, but they can tear and become inflamed. Repeated stress or pressure on the fascia where it attaches to the heel bone can cause microtears and painful inflammation. If not corrected in time, the inflammation and tension on the fascia can tug on the membrane surrounding the heel bone. This type of stress prompts the body to lay down additional bone, which forms a spur and can add to the discomfort.

Plantar fasciitis is sometimes referred to as heel spur syndrome. Bone spurs on the heel are actually a result, not the cause, of the problem. Surgery to remove a spur neither solves the problem, nor is it likely to relieve the disabling pain. Plantar fasciitis is most often an overuse injury that afflicts those who use their feet extensively for running, walking, stepping or prolonged standing. It is a classic repetitive stress injury that, if recognized and treated early, can be readily overcome. If ignored, the injury will only get worse until it becomes completely disabling.

Who Gets Plantar Fasciitis?
Plantar fasciitis can afflict anyone who participates in weight bearing activities. Persons at greater risk of getting this disorder are:

• Those who have either highly arched or flat feet.
• Those who are overweight.
• Those whose feet pronate, or roll in, causing the arch to collapse excessively with each step.
• Those who have inflexible calf muscles and a tight Achilles tendon (both place extra stresson the fascia).
• Those who begin an exercise program and do too much too soon.

The pain is worse after resting. A classic symptom is pain in the forward part of the heel. It is often most severe with the first steps taken after getting out of bed or after prolonged sitting. This is probably due to the tearing of scar tissue that has begun to form during the period of rest. Most people describe the pain as feeling like a bone or stone bruise.

Treatment
Treatment starts before getting out of bed by lightly stretching and warming your calf muscles. This is done by pointing your toes toward the ceiling and making circles with your feet. Never go barefoot, wear slippers or shoes without a raised heel. Wear high quality running shoes because they are well- padded and have somewhat elevated heels. Fit all your shoes with orthotics that support the arch and elevate the heel. The elevated heels help shift your weight forward, taking pressure off the heel.

Regular use of an over-the-counter anti-inflammatory pain medication, like ibuprofen or aspirin, is almost universally recommended, especially before performing an activity that stresses the fascia. One of the best preventive measures is to walk regularly, covering 1-1/2 miles in 15 to 20 minutes, three times a week. People tend to take full strides on long walks, stretching the muscles, tendons and ligaments. When people walk around an office or at home, they tend to take short steps, which does not properly exercise their lower legs and feet. Some alternative exercises are swimming, pool running and cycling (in low gear).

Before and after any activity, stretch your calf muscles and Achilles tendon. Repeat the stretches several times during the day. Reduce the intensity, frequency and duration of your activities. If you are a runner, avoid hills and speed work. If you are accustomed to doing one long workout, break it up into two shorter ones.

To help stretch the fascia, put a golf ball under the base of your big toe and roll the foot forward over the ball, then back again; then move the golf ball to the base of the second toe and repeat. Do the same motion starting at each toe, always exerting enough pressure so that you feel a little tenderness.Strengthen muscles of the foot by picking up marbles or golf balls with your toes (see diagram).

Another technique is to grab a towel with your toes, pull, release, grab, pull, release and repeat.

Ice the area for 15 to 20 minutes several times a day. To do this, fill a paper cup with water and freeze. Peel off the paper, place the ice under your foot and roll the foot over it (from the heel to the ball of your foot and back again.) A frozen juice can works as well.  

Exercises
Wall stretching - Plantar fascia and Achilles tendon stretching are very important. Lean forward against a wall, keeping one knee straight while you bend the other knee. The painful foot is placed further away from the wall. As you bend forward, you can feel your heel cord and the arch of your foot stretch. Keep your heel on the ground. STRETCH AND HOLD FOR 10 SECONDS, then relax and straighten up, then STRETCH AGAIN. Repeat this procedure 20 times. If both of your heels hurt, then you should reverse your leg position and repeat the exercise for the other foot.

Seated stretching - Sit in a chair and place one foot over the opposite knee. Grasp the outer side of the foot and pull up gently. 

Stair stretching - With one heel hanging over the edge of the step, support your weight on the front of the foot and apply steady downward pressure.

If everything above fails to relieve life-disrupting pain, surgery to release the fascia is the treatment of last resort. The surgery, which can be done on an outpatient basis under local anesthesia, involves snipping away part of the fascia where it is being pulled. Heel spur surgery, on the other hand, is not recommended. To learn more, call Minnesota Sports Medicine at 612-273-4800.