The Spring in Your Step: Plantar Fasciitis Explained

Plantar fasciitis is one of the most common causes of chronic heel pain in adults, affecting the young and old, the active and sedentary. Spanning from the heel to the balls of the foot, the plantar aponeurosis is a thick, superficial band of fascia that is responsible for supporting the longitudinal arch of the foot during ambulation.

Discomfort of this fascia is seen most often in athletes with abnormal foot alignment (pes planus [flat feet], pes cavus [high arches], and leg length discrepancies. These causes are all associated with tight intrinsic foot musculature or heel cord and can be precipitated by overuse, poor footwear, inadequate playing surfaces, or improper conditioning.

Characteristics of Plantar Fasciitis

Despite the inflammatory process implied within its name, the understanding of this injury has since evolved into one more of a degenerative nature and has since been characterized by pain in the medial heel that is exacerbated by weight-bearing activity. The injury is often chronic, with some reported symptoms persisting for more than a year.

Plantar Fasciitis Risk Factors

Associated risk factors include increased plantarflexion range of motion, presence of heel spurs, and body mass index (BMI). Researchers found no association of the fasciopathy and BMI in the athletic population, but there was evidence to support a relationship among the non-athletic population. There were weaker associations studied regarding previously alleged risk factors such as ground reaction forces, increased age, and prolonged standing.

Symptoms of Plantar Fasciitis

Upon evaluation, patients typically report a gradual onset of dull, achy pain and stiffness on the plantar surface of the foot, extending from the heel to the metatarsal heads. Pain is reportedly worse with the first steps in the morning or following prolonged sitting. Pain is typically relieved with activity (increased circulation) but may be exacerbated if the activity becomes prolonged.

Palpable tenderness and tightness will be noted near or directly over the heel, and prolonged heel pain may provoke the development of heel spurs. Although heel spurs are not the cause of a plantar fasciopathy, they are a result.

Plantar Fasciitis Treatment

This fasciopathy is typically a self-limiting condition, with a great percentage (80% - 90%) achieving symptomatic relief within three to six months of consistent, conservative treatment. Initial intervention includes administration of NSAIDs, stretching of the gastrocnemius (calf) and plantar fascia, and utilization of orthoses (heel pads, heel cups, arch supports, night splints, etc.).

Some health care providers recommend rolling out the fascia with a tennis or golf ball at night before bed or even a frozen water bottle (combining efforts of massage and cryotherapy). Other conservative treatment methods include extracorporeal shockwave therapy, needling, low-level laser therapy, and manual therapy (soft tissue / joint mobilization). Researchers found that manual therapy coupled with stretching or strengthening yielded greater improvements in function and pain pressure thresholds.

Our feet play such a vital role in posture and ambulation, and are seldom able to get a day off. Therefore, it’s encouraged that we continue expanding our knowledge and understanding of effective treatment options available for when an injury occurs.

Wrakyia Platt-Gregg, MS, ATC, SCAT is a MUSC Health - Florence Athletic Trainer. Learn more about MUSC Health Sports Medicine.

References

Biel, Andrew. “Leg & Foot: Plantar Aponeurosis.” Trail Guide to the Body: A Hands-On Guide to Locating Muscles, Bones and More, 5th ed., Books of Discovery, Boulder, CO, 2014, pp. 404–404.

Latt, L. Daniel, et al. “Evaluation and Treatment of Chronic Plantar Fasciitis.” Foot & Ankle Orthopaedics, 2020, pubmed.ncbi.nlm.nih.gov/35097359/.

Rhim, Hye Chang, et al. “A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis.” Life (Basel, Switzerland), 24 Nov. 2021, pubmed.ncbi.nlm.nih.gov/34947818/.

Shultz, Sandra J., et al. “Chronic or Overuse Soft Tissue Injuries: Plantar Fasciitis.” Examination of Musculoskeletal Injuries, Human Kinetics, Champaign, IL, 2016, pp. 426–427.