REHAB IN MOTION: The foot of the problem
Plantar fasciitis. Although it sounds like some obscure tropical disease, it is actually an inflammation of the plantar fascia, a thick fibrous band of tissue in the bottom of the foot that runs from the heel to the base of the toes.
When placed under too much stress, the plantar fascia stretches too far and tears, resulting in aggravation of the fascia and the surrounding tissues. The tears are soon covered with scar tissue, which is less flexible than the fascia and much more painful to walk on. Plantar fasciitis is characterized by pain at the base of the heel. Sometimes it can be severe enough to prevent you from walking. Often the pain is most severe in the morning when getting out of bed. The pain may fade for a few minutes as you start walking, but usually gets worse again as the day progresses.
Plantar fasciitis can be caused by many different factors. Tight calf tendons can cause tension and pulling on the plantar fascia. Overpronation, where the feet rotate too far inward when the foot impacts the ground, can increase the stress on the plantar fascia and cause aggravation. Poorly fitting, or old shoes, walking all day on hard surfaces, and running too much without proper recovery time, can also contribute to the development of plantar fasciitis. In very mild cases the application of ice for ten minutes every two hours, and resting to allow the plantar fascia to heal properly may be enough to fix the problem. One of the best ways to ice the bottom of the foot is to fill a plastic 500 ml bottle with water, and freeze it. Apply the ice by rolling the bottle under the foot. Just don’t leave the bottle out where someone might drink the water.
More serious cases are usually more difficult to fix. Generally, a combination of solutions to decrease the stress through the plantar fascia will allow it to heal. These solutions may include decreasing the amount of time training, or walking on hard surfaces, getting an orthotic to correct foot position, and doing specific stretches and strength exercises to support the plantar fascia. Taping or bracing can sometimes be used effectively to give the plantar fascia the support it needs to heal. A physiotherapist can help you correctly diagnose the cause of your plantar faciitis and give you suggestions to help decrease the stress through the fascia.
About 90 per cent of people with plantar fasciitis improve significantly after two months. If the plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If the symptoms persist your doctor may prescribe a walking cast or a splint to wear at night. In very rare cases, surgery is necessary to release the plantar fascia and relieve the pain.
Ben Chatterson is a physiotherapist at Rehabilitation in Motion. Visit www.rehabinmotion.com