Plantar Fascitis
Do you have:
- foot pain with the first several steps in the morning and lessens after 20 minutes of walking
- deep ache or tenderness at your heel
- tightness in calves or hamstrings
- pain that worsens as activity progresses and becomes most intense at the end of the day.
Plantar fasciitis is usually caused by:
- Improper joint mechanics in your ankle, knee or hip
- Muscle contractors in your calves, hamstrings or gluteus
Plantar fasciitis is the most common cause of heel pain in adults and afflicts women more frequently than men. It is often seen in runners, tennis players, and people who stand or walk at work. The classic symptom of plantar fasciitis is heel pain that typically is worst with the first several steps in the morning and lessens as walking continues. Individuals often have pain at the beginning of an activity that diminishes or resolves as they warm up. Generally symptoms recur after the activity and frequently the pain is described as a deep ache or tenderness at the anteromedial region, inside front area of their heel. The pain can be accompanied by stiffness, sharp shooting pain, localized inflammation, and becomes most often intense at the end of the day.
The plantar fascia originates from the medial calcaneal tuberosity (heal bone), fans out across the sole of the foot, and inserts into the toes. This dense band of tissue supports the medial longitudinal arch of the foot and provides dynamic shock absorption. At the beginning of the stance phase of the gait cycle, shortly after heel strike, the tibia rotates internally, and the foot pronates, stretching the plantar fascia as the foot flattens. Because the fascia has no elastic properties, repetitive stretching results in micro tearing and inflammation at its origin. Repetitive micro tearing of the plantar fascia leads to collagen deposition at the medial tubercle of the calcaneus, which eventually causes heel pain. Scar tissue can accumulate, further worsening pain and limiting functionality.
Several predisposing factors can excessively stretch a tight plantar fascia and thus lead to repetitive micro tearing. This may include training errors, improper footwear, change in distance or intensity of physical activity, change in running or walking surfaces, decreased plantar flexion strength, reduced flexibility of the calf muscles, tight Achilles tendon, excess pronation, discrepancy in leg length, bone misalignments, and obesity or sudden weight gain (as in pregnancy).
Plantar fasciitis is generally a self-limited condition. Unfortunately, resolution can take 6 to 18 months, which can be frustrating. Although the condition is usually self-limited, it is a great mistake to ignore getting treatment. The longer the symptoms exist, the more tearing will take place and the less likely healing will occur. This can progress into bone spurs and calcium deposits at the point of attachment in the heel. If left untreated, surgery may be required to remove these bony deposits.