By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Plantar fascitis is considered the most common cause of heel pain. The plantar fascia is a thick band of tissue that connects the heel to the toes. From the heel the connection continues up the backside of the calf. The plantar fascia also has a poor blood supply exposing it to chronic overuse conditions.
The primary symptom of plantar fascitis is foot pain when taking the first steps after getting out of bed in the morning or after sitting for a long time. The stiffness and pain may reduce after taking a few steps. But your foot may hurt more as the day goes on. It may hurt the most when climbing stairs or with prolonged standing or running. There are many contributing factors leading to plantar fascitis. Most of us would like a nice neat cause and effect answer to the question, “What causes plantar fascitis?” For instance, if you are a long distance runner, running endless miles alone won’t cause plantar fascitis. However, if you run endless miles with worn running shoes or fail to maintain Achilles tendon flexibility and hip strength then you may develop plantar fascitis. As you can see, several factors need to be in place to develop plantar fascitis.
While there have been significant advances in shoe materials and technology it is the structure of today’s footwear that may be contributing to the development of plantar fascitis. Most forms of footwear have a built in “heel-lift”. This means that the heel is higher than the toes. This chronic “heel-lift” causes the calf to tighten and subsequently increases the forces on the plantar fascia. The end result can be plantar fascitis. Why don’t shoe manufacturers make shoes without a heel lift? They tried that in the 1970’s and it failed. They were called “Earth shoes”. Most people didn’t like “Earth shoes” because it made their legs hurt. Had most of us prepared ourselves to wear “Earth shoes” by stretching regularly we may have avoided that pain. Heel lifts are effective at reducing pain because they shorten the tissue. But used chronically they cause tightness.
Patients with flat feet or high arched feet will experience plantar fascitis for two different reasons. A flat foot has too much motion, chronically stretching the tissue. A high arched foot is very rigid and cannot absorb forces very well. Patients with flat feet actually have more treatment options than those with high arched rigid feet.
Weakness of the hips can cause the feet to flatten at a faster rate than the tissues can accept. This results in a rapid stretch on the planter fascia causing chronic micro injuries to the tissue itself. If the weakness is left uncorrected a stubborn case of plantar fascitis may occur.
There are many different ways to manage and treat plantar fascitis. Unfortunately, many of these treatments are focused on the area of the plantar fascia that is symptomatic and fail to account for the variety of contributing factors. Even the best treatment can fail if the stimulating factor is not addressed.
The most common “treatment” is the prescription of orthotic devices or shoe inserts. An orthotic is most beneficial when combined with a flexibility program for the Achilles tendon and a strengthening program for the hips. There are many different types of prescription and over the counter orthotics that can help patients with flat feet. Patients with high arched rigid feet should see a podiatrist for custom orthotic shoe inserts. Remember that your new orthotic shoe insert should not be placed on top of the shoes original insert. It is also a good idea to get a new pair of shoes, athletic or otherwise for your new inserts.
There are many other types of soft tissue treatments such as Active Release TechniquesÂ® (www.activerelease.com) or instrument assisted soft tissue mobilization (www.sastm.com) that address poor blood flow in the tissue or scar tissue build up. These techniques are valuable when combined with flexibility and eccentric type strengthening exercises. Extra-Corporal Shock Wave Therapy (ESWT) is new and has had some promising results with plantar fascitis and heel spurs in particular. Also on the horizon is the platelet rich plasma or PRP injection. In many cases of stubborn plantar fascitis, several or all of these options need to be combined with the appropriate exercise program in order to achieve the desired result.
Lastly, recognizing when your shoes have had enough and you simply need new or better shoes can be the difference between a quick recovery or falling into a chronic and lengthy problem. Shoes don’t last as long as we think and most shoes are the definition of planned obsolescence. In most cases, foot pain does not resolve on its own. Finding out the cause of the pain is the first step in making it go away.