The plantar fascia is a large band of fibrous tissue that runs along the bottom of the foot, from the front of the heel to the beginning of each of the five toes. It functions mainly as a shock absorber and support for the arch of the foot. It withstands a great deal of pressure when weight bearing and serves protects the foot in this way. When there is too much pressure, the fascia becomes damaged and injured, resulting in inflammation (our bodies natural response to injury). Inflammation of the plantar fascia is termed plantar fasciitis. The most common symptom of plantar fasciitis is heel pain. This pain is worst in the morning and can be excruciating during the first few steps after getting out of bed. Other common symptoms include an increase in pain after activity, tight calves (gastrocnemius and soleus), and difficulty with dorsiflexion (bringing the toes up towards the shin).
Plantar fasciitis is typically caused from overuse to the fascia. This could be from an increase in activity or an increase in stress to the tissue, such as standing for long periods of time on a hard surface without proper foot support. Foot support in general is another common cause of plantar fasciitis. Pronation is the motion that occurs when the foot hits the ground when walking. During this motion, the foot rolls inward and flattens the arch, putting the plantar fascia on tension. Excessive pronation without proper arch support will repeatedly stretch the plantar fascia beyond its natural ability and will essentially become damaged. Repetitive impact activity such as running and walking can place an extreme amount of stress on the plantar fascia that will increase the chances of inflammation. Obesity is another common cause of plantar fasciitis, since there is more force (i.e. more weight) being placed on the plantar fascia.
Physical therapy is an important part of the treatment process of plantar fasciitis. A physical therapist will perform a series of tests and measures to rule in a plantar fasciitis diagnosis. A biomechanical foot exam will be performed to evaluate arch type as well as a gait analysis to observe the mechanics of the foot. Other tests and measures include range of motion and strength of the leg and determining where tenderness occurs along the bottom of the foot. Physical therapy treatment will include exercises to help strengthen the small muscles in the foot, stretching and range of motion to the leg (particularly the calf muscle), and massage. Transverse friction massage will increase the blood flow to the plantar fascia, which helps with healing. Ice massage may also be used, which involves rubbing an ice cup along the bottom of the foot and at the heel where the plantar fascia originates. Rest is an important factor in the healing process as well as proper arch support. A physical therapist can recommend certain shoes and orthotics that will best support a particular arch. The combination of rest, stretching, proper foot wear, and physical therapy provides the best prognosis for a full recovery from plantar fasciitis.