Plantar Fasciitis

Anatomy and Injury

The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot from the heel bone to the ball of the foot.  Along with many tendon injuries that have long been called tendinitis and are now labeled as a tendinosis, this diagnosis is now thought to be more accurately termed plantar fasciosis.  This is due to studies of the tissues where disorganized fibers within the tissues are found rather than inflammatory cells.  What does this mean in the real world?  Treatments targeting inflammation, although questionable even if inflammation was present, are pointless as there are no signs of inflammation after the first couple of weeks of this injury.  Thus, the key to resolving this issue is helping the disorganized fibers in the plantar fascia on the bottom of the foot to become more organized.^1,2,3,4 Although this injury can be caused by a single traumatic event (stepping on a hard object, such as a stone…or walking in ill-fitting shoes around the LAX airport parking lots for 4 hours because you forgot where you parked, which was a good reminder for me about the iphone camera), its typically a repetitive use injury such as walking, running, or hiking farther than normal. Other factors like old or poor footwear, walking on different surfaces than normal, injuries “further up the chain” (knee, hip, low back) causing gait abnormalities, and a lack of flexibility can play a role.

Symptoms

Significant pain is typically noticed on the bottom of the heel when getting out of bed and upon standing after prolonged sitting.  Pain is also noticed with walking and prolonged standing.

Prevention

1. Footwear: Replacing walking, hiking, or running shoes every three months or 500 miles has been recommended to prevent this injury.⁵ Being properly fitted at a reputable shoe store (we’re lucky to have Sage to Summit and Eastside Sports in Bishop) for your specific foot type is also a good idea.
2. Stretching:   Plantar fascia and calf stretches are key to keeping a normal length to these structures so they do not irritate the attachment point on the bottom of the heel.^1,2,6 (See pictures for stretches below in the treatment section)
3. Preparation:   Get the body ready for unusually long walks, hikes, or runs by gradually increasing distance and elevation gains or losses.  Using appropriate footwear, such as shoes with good arch support for people with low arches, can help prevent irritation of the plantar fascia.
4. Trigger points/myofascial restrictions:   Periodically check for any trigger points/myofascial restrictions in the gastrocnemius, soleus, and muscles on the bottom of the foot.²  The goal is to find any spot that feels tight or tender and hold direct pressure for 2-3+ minutes while feeling for a release (you may notice the pain lessen or the tissues soften).  See the treatment section below for pictures of treatment examples.

Treatment

This injury can turn into a very long rehabilitation process if it is ignored (months or even years!).  The areas on which to focus include:
1. Avoid any activities that increase the pain as much as possible.  Consider temporarily switching your walking/running routine to cycling or swimming and avoid walking barefoot.  Walking, hiking, or running shoes should be replaced after roughly 500 miles.⁶
2. Range of motion:  Pump your ankles (bring your toes towards your nose and then push them towards the floor) 10 times prior to standing after you have been lying or sitting for prolonged periods.

3. Stretching:   Plantar fascia, gastrocnemius, and soleus stretches will help the disorganized fibers to line up properly to heal the area.^1,6,7  Hold the stretches for 30 seconds and repeat 2-3 times, 2-3 sessions per day.

4. Trigger points/myofascial restrictions: Assess for trigger points in the gastrocnemius, soleus, and muscles on the bottom of the foot.^2,4,8

5. Night splint:   This is a splint worn at night to keep the plantar fascia and calf muscles stretched out.  Research has shown that they can be beneficial.  It was previously difficult for some people to wear through the night due to discomfort trying to sleep with the foot wrapped in a brace, however they have greatly improved in comfort over the last several years.^1,6,7,8

6. Other:  Additional variables (joint mobility, footwear, posture/alignment, workplace or daily activity contributions, deficits in other areas of the body such as the knee/hip/low back etc.) can contribute to these symptoms and having an evaluation from a knowledgeable physical therapist can be beneficial.

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for further information and tips specific to climbing and plantar fasciitis as well as other foot disorders.  Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here.  My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

References:

1. Schwartz EN, Su J. Plantar Fasciitis: A Concise Review. Perm J. 2014 Winter;18(1):e105-7.
2. Renan-Ordine R1, Alburquerque-Sendín F, de Souza DP, Cleland JA, Fernández-deLas-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50.
3. Bass, E. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Int J Ther Massage Bodywork. 2012; 5(1): 14–17.
4. Ajimsha MS1, Binsu D2, Chithra S2. Effectiveness of myofascial release in the management of plantar heel pain: A randomized controlled trial. Foot (Edinb). 2014 Jun;24(2):66-71.
5. Glazer JL. An approach to the diagnosis and treatment of plantar fasciitis. Phys Sportsmed. 2009 Jun;37(2):74-9.
6. Davies C. The Trigger Point Therapy Workbook. New Harbor Publications, Oakland, 2004. pp.223-226.
7. Chinn L, Hertel J. Rehabilitation of ankle and foot injuries in athletes. Clin Sports Med. 2010 Jan;29(1):157-67, table of contents.
8. Beyzadeoğlu T, Gökçe A, Bekler H. [The effectiveness of dorsiflexion night splint added to conservative treatment for plantar fasciitis]. Acta Orthop Traumatol Turc. 2007;41(3):220-4. Turkish.