Do your first few steps out of bed in the morning cause severe pain in the bottom of your foot or heel? Or does your heel hurt after jogging, skiing or playing tennis?

Most commonly, heel pain is caused by inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis  (fashee-EYE-tiss).   Plantar fasciitis occurs because of irritation and inflammation of the thick ligamentous connective tissue that runs along the bottom of the foot, usually due to overuse. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on this tissue is tremendous.  Any time that stress is placed on a tissue there is potential for developing scar tissue in that area, and a portion of treatment should be directed towards  breaking up and getting rid of the tense, brittle and inflexible tissue in this condition.

There are a number of plantar fasciitis causes. The plantar fascia ligament loosens and contracts with movement and also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons, the most common being an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and commonly suffer from it. Excessive running, jumping, downhill skiing or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage.   Also, a lack of stretching before and following activity can lead to tightened muscles and tendons and result in inflamed tissue.

Another common cause of plantar fasciitis is arthritis. Certain types of arthritis can cause inflammation to develop in tendons, resulting in plantar fasciitis. This cause is particularly common among elderly patients.  As we age, tissue tends to become weaker and more prone to damage. In addition to these common risk factors, weight plays a huge role in damage to the heel. Since our heels absorb much of our body’s pressure when we walk, being overweight can easily lead to damage and plantar fasciitis. Pregnancy can also add a few extra pounds. However, the hormonal changes in pregnant women can also cause ligaments and other tissue to relax and become more pliable, which could lead to plantar fasciitis if you are not careful. Those who are on their feet all day due to their occupation are also at a risk.

Plantar fasciitis is also influenced by the mechanics of the foot. Having conditions such as flat feet, high arches, pronation, improper pelvic or hip motion or having an abnormal gait (the way in which the foot hits the ground), the fascial tissue can become overworked or stretched abnormally, resulting in tears and inflammation.    For this reason it is important to maintain proper body biomechanics to prevent conditions like this from developing. Also maintaining proper lower leg muscle flexibility is crucial in balancing the stresses put on the foot with standing, walking or other activities.

At home treatment should consist of stretching and icing.  Freezing a plastic water bottle and then rolling the bottom of the foot on it is a nice way to combine these two at home treatments.  In office treatment options include soft tissue mobilization, myofascial release, manual therapy, ultrasound, laser therapy, Kinesiotaping™ (supportive taping for inflammation), and scar tissue and adhesion removal. Cortisone injections have been used for this condition, but may ultimately weaken the tissue and lead to further problems.  Nutritional support is aimed at reducing inflammation.  This may include maintaining a low inflammatory diet, one low in sugar and processed foods, supplementation with omega 3 fatty acids and proteolytic enzymes, and the use of topical creams that contain Arnica, MSM, and Boswelia.  Surgery is not a common treatment option for plantar fasciitis, but has been used in extremely chronic cases.

There is hope for those suffering from this painful foot condition, and with proper treatment and preventative measures we can keep this from occurring again.

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