Plantar Fasciitis

It was a beautiful day after days of clouds and rain, so I took off on what turned out to be a 10 mile training hike through northeast Eugene. The hike was fun, I saw some new territory, and when I finished my right heel was tender. No problem. Probably just a little bruise. It will be better in a day or two. Nope, the pain is still there after more than 2 weeks. What is going on? 

Plantar fasciitis is a particular type of heel pain that generates over one million doctor visits a year in the U.S. to the tune of over $ 192 million. It can be caused by direct and significant trauma to the heel, but much more commonly is the result of overuse (read multiple micro traumas.) There are a number of other reasons for heel pain, and they must be ruled out, but the number one leading cause of heel pain is plantar fasciitis. So what is it. 

The plantar fascia is a thick band of connective tissue that is attached to the heel and then forward to the base of the toes. (See illustration) Think of the foot as a bow, the kind you shoot arrows with. If the arch of your foot is the bow, then the plantar fascia is the string for that bow. It holds the shape of the foot from collapsing flat and adds some shock absorption for good measure. 

It appears that the attachment at the heel, where your foot hits the ground first while walking, is subject to a lot of wear and tear, with emphasis on tear. It is thought that micro tears at the attachment point lead to the pain and non-healing continues the pain. Non healing is the result of the fascial tissue degenerating around the tear site possibly due to the lack of a significant inflammatory response. Inflammation brings in repair cells and accelerates the healing process. This lack of response makes for slow healing, a hallmark of plantar fasciitis. 

But the main hallmark of plantar fasciitis is: sharp pain to the bottom of the heel with the first few steps getting out of bed or after sitting for a long time. The pain subsides with activity initially, but may get worse throughout the day with use. Usually non-painful when not weight-bearing. Often there is a precipitating event, like an increase in exercise, change of shoes, or foot trauma. 

After ruling out the more than 30 other things it could be, which could require x-rays, or other scans or labs, then how do you treat it? Good question. It usually will get better on its own, but it can take months. Obviously, backing off of the exercise that caused it is a good start. Doing runner’s stretches pre and post exercise and icing are also recommended. Getting a foot/ankle splint that keeps the foot at a right angle while sleeping is actually pretty effective. Since most people flex their toes down when they sleep, thus shortening the plantar fascia, when they get out of bed and take the first steps and stretch the fascia, it tears a little more, Ouch! Keeping the foot at a right angle with the leg, stretches it out so that it doesn’t tear with the first step. 

If there is no improvement after a few weeks, or it is getting worse further workup may be needed. There are injections that can be done to help and as a last resort there is surgery. 

I have cut back my distance on my training hikes, walking only on flat ground, and on dirt or bark paths while avoiding hard surfaces as much as possible. I’ve got good cushioned supportive shoe, too. I sleep with a right angle splint and my pain is very much less now, but not gone. I suspect it will be a few more weeks, before it is totally gone and if not, I will see my Podiatrist. 

See you back in 2 weeks,