The plantar fascia—most people have heard the term—but what is it and why are so many people complaining about it? Why can the plantar fascia become so painful and irritating? The answer is because the plantar fascia is a structure that is crucial to a human’s ability to walk, and well, we walk a lot.
To break the term down to its root parts: Plantar is the sole of the foot and Fascia is a band or sheet of tissue, primarily collagen, that connects, supports, or separates. The plantar fascia is a structure that supports the sole of the foot, the connections from the heel to all five toes, and separates the layers of muscle. Plantar fasciitis is the inflammation of this structure.
Plantar fasciitis is the most common cause of heel pain but can also cause midfoot pain. It is usually a result of cumulative trauma. It is very common in those who have a flattened medial arch, placing more tension on the plantar fascia, and repetitive micro-traumas. Tight and weak calf muscles, known as the gastric and soleus also contribute to increased strain on the plantar fascia. Hamstring tightness is also associated in high rates with this condition.
The symptoms of plantar fasciitis are usually focused around a sharp pain with the first few steps in the morning or following a period of inactivity. The pain is noted in the push off phase of walking when the plantar fascia is taught. The push off phase and tautness of the plantar fascia is known as the windlass effect, this causes the structures of the foot to become rigid to allow us to propel forward in our stride.
Nurses, teachers, dancers, construction workers, cooks, distance runners, and all other professions that require prolonged ambulation are predisposed to developing plantar fasciitis. Symptoms are intensified by prolonged standing and compounded by inadequate foot support or walking barefoot. As summer is upon us and warm weather shoes are being worn, be cautious of footwear choices if you will be standing and walking for long periods.
Treatment of plantar fasciitis is important to prevent chronic pain and potential for rupture. The patient may need to limit activities such as jumping, running and sprinting that exacerbate the pain. Immobilization of the foot with the plantar fascia lengthened is shown to improve recovery time. A Strassburg sock can be worn at night while sleeping.
Medical management can include anti-inflammatory medications, extracorporeal shock-wave therapy (ESWT), cortisone injections and surgery.
Dr. Allison Fleming and