Did you know that up to 10% of our population will experience heel pain at some point in their lifetime? Sometimes this can be Plantar Fasciitis (PF). PF is not diagnosed with a specific test, but rather by a pattern of symptoms. These include:

  • pain that starts gradually for no apparent reason, and then progressively gets worse
  • pain in the front/inside of the heel when first stepping on the foot in the morning; there may also be pain in the middle of the arch area
  • pain that diminishes once up and walking, but as the day goes on it returns
  • pain that diminishes with sitting and rest, but returns upon standing (especially true if symptoms have been present for more than 3-4 weeks)
  • feels better with running once you are warmed up, but comes back after standing, sitting or resting; tenderness to touch in the middle of the arch and toward the front of the heel

The plantar fascia is made up of 3 bands of connective tissue that protect the structures on the bottom of the foot but also help with shock absorption and supporting the arch when walking and running. The central band is the one that often becomes inflamed. It attaches to the front/inside of the heel, the point where pain typically begins.

Factors that appear to lead the development of PF include a higher body mass index, being on your feet more during the day and decreased flexibility of the ankle to dorsiflexion (flexing the ankle up). It has not been shown that people with increased foot pronation are at a greater risk for getting PF.

What should I do about it?

  • Anti-inflammatories: During the first 2-3 weeks of symptoms when the tissues are inflamed, icing, anti-inflammatory medication or modalities can be helpful. Once the symptoms have been present for more than 2-3 weeks, the tissues are in a chronic inflammatory state and anti-inflammatory treatment is less likely to help.
  • Orthotics: Either off the shelf or custom orthotics has been shown to be helpful for about 3 months; but then typically symptoms will come back. Underlying foot/ankle mobility or strength issues still need to be addressed.
  • Night splints: These have been shown to be helpful after symptoms have been present for 5-6 months, and then must be worn nightly for at least 2 months.
  • Stretches: Stretching the calf, the PF, the big toe to extension, and the ankle to flexion can be helpful. Strengthening: Exercises to strengthen the intrinsic small muscles within the foot are important.
  • Massage, joint mobilization/manipulation: all have been shown to be helpful.

Occasionally PF or heel pain can arise as a result of low back problems or direct trauma to the foot. If your heel pain isn’t getting better with time, it may be helpful to seek out the help and guidance of a physical therapist.

This article was written by Amira Ranney, Director of Mountain Physical Therapy in Asheville, NC.  The therapists at MPT are kind enough to contribute articles for our newsletters every other month as well as treat many of our clients.  For more information on MPT call 828-254-3525 or go to http://mountainphysicaltherapy.com