Plantar Fasciitis is one of the most common sources of foot pain. The pain is caused by excessive strain or microtears in the plantar fascia, which is the long, dense ligament which extends from the heel to the base of the toes. The Plantar fascia is the foot’s main structural support, as it transfers weight from the heel to the toes and provides spring as we walk or run.
The pain from Plantar Fasciitis can be felt anywhere along the bottom of the foot, but is most commonly felt at the base of the heel. (See fig. 1) The pain may be described as stabbing and sharp, and may be most intense in the morning or upon rising. The pain will often diminish as the person walks and the tissue warms up and becomes more pliable.
The causes for Plantar Fasciitis are multiple, and sufferers include athletes, dancers, and people who work on their feet for much of the day. Women who wear high heels, or people who have tight hamstrings, calves, or Achilles tendons will have a tendency to develop Plantar Fasciitis. Pre-teens may experience Sever’s Disease, a sort of “growing pains” disorder. Systemic diseases, such as rheumatoid arthritis can increase the odds of Plantar Fasciitis, due to arthritic changes or a degeneration in the heel pad of the foot. The effects of diabetes can include a lack of peripheral circulation and nerve transmission, and therefore have a negative effect on all tissues in the foot area.
Plantar Fasciitis may also be accompanied by bone spurs in the heel area. These may form as the tight fascia which attaches to the periosteum of the heel bone becomes so taut that it tugs this tissue away from the bone. The osteoblasts are our bone-building cells, and lie between the bone and the periosteum. They are constantly cleaning and rebuilding the outer surface of the bone. Repetitive strain to the planter fascia may pull the periosteum away from the calcaneus (heel bone), and create a little “tent”. The ever-dutiful osteoblasts will come to the rescue and fill in this gap, forming a bone spur. This may create the sensation of stepping on glass, along with the pain of a tight plantar fascia!
Ultimately, the cause for Plantar Fasciitis lies in the structure of the foot and the lack of support to the tissue of the plantar fascia. After all, this “trampoline” of tissue must bear our weight and also attempt to transfer spring to our step. Any lack of flexibility or muscular imbalances in the structures that are involved with locomotion can have a negative effect on the plantar fascia. This is especially so via the plantar fascia’s direct connection to the Achilles tendon, the calf muscles, and the hamstrings. These muscles in the back compartment of the leg must be in balance with the muscles in the front compartment of the leg. This is necessary for proper bony alignment, and ultimately the arches of the foot are hung in a sling of support from the musculature above. Any deviation to good alignment is “lurking” for the opportunity to come forth and create pain for the athlete or the worker who stands on a hard surface all day.
Treatment for Plantar Fasciitis should include rest and ice therapy to the area. Well-made orthotics can provide support for people with flat or high arches. A good home remedy is to roll a golf ball under the foot several times a day, to work out the pain-causing adhesions and restore flexibility to the fascia. The person who is truly interested in alleviating the source of the issue should look into Structural Integration, or Rolfing.