By Caroline Unger, MSPT, CSCS, EMT.  Caroline is a Physical Therapist at Genesis ElderCare in Manahawkin NJ.  She received her undergrad degree at Rutgers University and her Masters degree at the University of Miami.

It Hurts Where? 
Pain will usually occur most intensely on the bottom of the heel.  However, because the fascia runs along the length of the foot it is possible for pain to occur anywhere along the sole of the foot. 

Similar Injuries: 
Any athlete with plantar fasciitis should be monitored for heel spurs and/ or a stress fracture of the metatarsals.  If the injury does not improve with 3-4 weeks of rehab, then referral to an orthopedist or podiatrist should be considered.  Other injuries that can cause pain on the bottom of the foot include, metatarsalgia, neuroma, arch strain, and a foot sprain. 

How does it Happen? 
This fascia may become inflamed and eventually even tear if there is sufficient pressure exerted on the bottom of the foot.  This pressure may be the result of a sudden turn or landing that causes the arch to flatten or the toes to spread.  In most cases, however, plantar fasciitis develops over a period of time.  Some athletes are predisposed to this condition because of "pronating" feet.  This means the feet flatten and roll inward while walking or running.  Since the arch drops this causes added 
tension on the plantar fascia.  This particular problem is easily addresses with an orthotic that is placed in the shoe to mechanically support the arch and keep the arch ligament from straining. 

Interestingly, people with too high of an arch or pes cavus may also be at risk.  This type of foot is generally considered rigid and a poor shock absorber.  A special arch support can again be placed in the shoe to help "bring the shoe up to meet the foot". 

Treatment: 
One of the simplest things is try to avoid walking without shoes.  The more "padding" at all times the better shock absorption and less stress on the plantar fascia.  Sometimes shoes with very stiff soles are a culprit since extra force is required to bend the sole each time you push off with your toes during typical walking.  Part of the treatment includes controlling the inflammation. In severe cases a doctor may recommend a cortisone injection or oral anti-inflammatory medication. Icing the area at the end of the day and more often if able will be very beneficial. If rehabilitation has been recommended by the doctor, the physical therapist or athletic trainer may choose different modalities such as electrical stimulation, ultrasound, or iontophoresis to address pain relief as well control of the inflammatory process. 

You may also be advised to use a night splint.  Many people report that the most painful time is when they put their foot on the ground in the morning.  This is because the toes have been in a "down" position through the entire night which allows the plantar fascia to shorten.  Placing the foot on the ground causes an immediate stretch of this already tender and inflamed area.  The brace (or night splint) will place a comfortable but continuous stretch on the plantar fascia throughout the night, resulting in significant reduction of pain in the morning. A stretching and strengthening routine for the calf muscle group and intrinsic muscles of the foot is always essential to successful treatment. 

Participation Status: 
Return to "normal" activity will largely depend on the pain level.  An athlete should not return to running or jumping until she/he can manage standing and walking through an entire day without significant pain.  The force transmitted through the lower extremity multiplies 5-6x with running and even more with landing from a jump.  It is safe to say that if walking causes pain it will become worse with these activities and cause additional damage.  Be sure to ice after the first few times you try returning to these new activities - even if it feels good at the time. 

Once it's back to normal ... the athlete should continue to use their orthotics if they were recommended, even if all symptoms resolve.  They're one of the keys to preventing re-injury as well as good footwear with shock absorption qualities.  Be sure to maintain adequate flexibility of the calf muscles and plantar fascia.  Maintaining your optimal body weight is also essential to prevent additional stress on the plantar fascia.  Try to intersperse prolonged periods of standing and walking with periods of non-weight bearing.  Return to the exercise routine and icing frequently if you feel the symptoms returning, but that won't happen in most cases if you've taken all the right steps.