Ortho-profile: Plantar Fasciitis

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If you’re an exerciser you will undoubtedly have foot pain from time-to-time, after all you spend most, if not all of your exercising time on your feet. For some, this pain can become chronic, more severe, and in some cases very debilitating. If you have progressed to this point you may have plantar fasciitis (PF).

What is PF?
PF is the irritation, damage (strain), inflammation in the band of tissue that supports the arch of the foot. This basically connects the heels to the toes and it plays a critical role in walking, running, jumping, and most sport-oriented activities.

What are the Symptoms of PF?
Symptoms will vary, but tend to involve sharp pain in the bottom of the foot. The pain will be located mid-foot-to-heal. Symptoms tend to be worse first thing in the morning (or after not load bearing for a while), after walking barefoot, or after engaging in more impact based activity.

As I said above, anyone who is active and on their feet a lot is at risk for developing PF, however certain things can put individuals at greater risk:

  • Very high or very low (flat) arches
  • Overweight
  • Significant increase to impact-based exercise volume
  • Tightness in the Achilles tendon
  • Hip instability/weakness
  • One leg being longer than the other
  • Wearing the wrong shoes with inappropriate arch support (too little or too much)

I realize these sound incredibly varied and some very non-specific, but PF is complex. In fact, in most cases it is a combination of these issues that result in PF occurring and it is therefore a combination of treatments that get it better.

Treating PF?
Effective treatments for PF vary widely. If after hearing the above symptoms, you think you may have PF, consult your physician for the diagnosis and the appropriate course of action with regard to treatment.

Once PF is diagnosed a number of different modalities may be used:

  • Ice
  • NSAIDs (Nonsteroidal anti-inflammatory drugs, like Ibuprofen)
  • Reduction or complete rest of activities that cause pain (this can even mean limiting walking in some severe cases)
  • Night splinting
  • Ankle and foot stretching
  • Ankle and foot strengthening
  • Massage
  • Arch supports
  • New footwear
  • Acupuncture
  • Strengthening weak hip muscles

Time course of treatment for PF can vary widely as well. Since its affects and underlying causes are so variable, some people will respond very well to basic treatments like ice and NSAIDs. Others require significant reductions in activity and fairly intensive therapy. Finally others have to look at more complex factors like imbalances at the hip, running/jump mechanics, weight loss, and footwear.

How to Prevent PF?
The best way to prevent PF is to ease into impact-based activity (like running and jumping). Start with very limited, low impact and then progress from, there. Some other strategies are as follows:

  • Wear supportive shoes
  • Perform impact-based exercise only after you’re at a healthy body fat and body mass
  • Strengthen up the ankle complex in all its planes of motion (toes pointed in, out, towards, away).
  • Have strong posterior leg muscles to aid in impact reduction (“shock absorbing”)

Know the warning signs mentioned above and taper activities that irritate the bottom of the foot – it’s never worth it to just “push through!”

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