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.
What is it?
Plantar Fasciitis refers to an inflammation of the plantar fascia - a
ligament which runs from the heel to each of the five toes. It serves
as an elastic guide wire to support the bottom of the foot, especially
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.
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".
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
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