Plantar Fasciitis 101

Why do my feet hurt?

The foot is a complicated structure made up of 26 bones and 33 joints. Proper function and alignment of all of these structures is important to prevent foot pain. Despite how complex this system is, there are common patterns that can lead to certain types of foot pain.

Your doctor may have mentioned to you that you have “flat feet” or “fallen arches” but what does this really mean? Everyone has an arch in their foot. The height of this arch can vary from person to person. More important than the height is how the arch acts when you stand on it. Excessive collapse through the arch when you stand stresses the soft tissues of the foot, in particular, the Plantar Fascia.

The Plantar Fascia is a thick ligament which attaches to the heel bone (calcaneus), spans across the bottom of the foot in a fan shape, and attaches to the ball of the foot. This strong fibrous structure supports the arch of the foot and provides shock absorption when you walk, run or jump.

What is Plantar Fasciitis?

Plantar Fasciitis is a common foot problem at many stages of life. It usually starts as a dull, often intermittent pain in the heels which may progress to a sharp persistent pain. Often it is worse with the first few steps in the morning, after sitting a short time, or at the beginning of a sporting activity.

Sometimes foot pain due to plantar fascia can grow gradually worse, other times it seems to come “out of nowhere”. In either case, there is typically an underlying mechanical issue with the foot that has been ongoing for a long time. In some cases, a rapid increase in activity, wearing improper shoes, or going barefoot more than usually can cause the problem to worsen suddenly. Once the area is inflamed to the point of pain, it can be challenging to resolve without treatment. Treatment of the underlying mechanical issue is important to not only reduce your pain in the short term, but to prevent it from recurring.

Pain from Plantar Fasciitis usually occurs when the plantar fascia is pulled away from the heel bone, however sometimes the “tearing” takes place in the centre of the foot or towards the toes. Inflammation and pain is the common result. As the fascia pulls away from the bone, the body reacts by depositing calcium in the space resulting in a heel spur. Once the problem progresses to this point, the pain makes it difficult to bear weight on the heels resulting in a modified gait and reduction in activity. These symptoms may start one foot initially but may progress and affect both feet over time if left untreated.

Why do I have this problem?

There are a number of factors that may increase your risk of developing Plantar Fasciitis

These Include:

1. Flat or pronated feet (collapsed arches)
2. High-arched, rigid feet
3. Improper footwear
4. Sudden increase in activity
5. Running on hills or up and down stairs
6. Increased age
7. Tight achilles tendons/ calf muscles

What can I do to treat this?

There are many treatments for Plantar Fasciitis which target the symptoms ( ie. pain and swelling). Those treatment programs include icing, anti-inflammatory medications, cortisone injections to reduce pain in the area, and shock absorbing heel pads. These treatments are beneficial for temporary relief of discomfort associated with Plantar Fasciitis, but do not deal with the underlying causes. Plantar Fasciitis is often related to tight muscles in the ankles, or a misalignment within the foot. Stretching your calf muscles, and realigning the foot position are often very effective ways to reduce pain.

A custom-made foot orthotic can realign the foot position, and provide support and cushion to the structures of the foot. This helps to relieve the stress on the plantar fascia, and give the ligament a chance to heal.

Treatment which targets the cause of the pain and inflammation is effective in reducing these symptoms for the long term and allows the damaged soft tissue to heal while maintaining regular activity. This program includes:

1. Custom arch supports from a Certified Orthotist  (C.O(c))
2. High quality supportive footwear

In addition, your doctor or Orthotist may recommend:

1. Anti-inflammatory medication
2. An Achilles tendon stretching program
3. Night resting splint
4. Physical therapy
5. Cortisone injections

These therapies may be combined to improve results, but in order to create a lasting change, the underlying mechanical cause of the issue should be dealt with. This typically means stretching, physiotherapy exercises, and mechanical realignment.

Custom made foot orthotics are arch supports contoured to a person’s foot and must incorporate a fine balance between support and flexibility. A good arch support should allow for movement within a normal range, while preventing excessive collapse or pronation of the foot. The arch support may be wedged (thicker on one side) to improve alignment and could incorporate additional support just behind the ball of the foot. Cushioned heel pads, or temporary heel lifts may also be necessary depending on your symptoms, foot alignment, and ankle mobility.

Custom made foot orthotics are covered by many private insurance plans. If you are dealing with symptoms of plantar fasciitis, foot orthotics would likely be of great benefit to reduce pain and improve mechanical alignment.