Heel pain affects approximately 10% of North Americans in their lifetime. The most common cause of pain on the bottom of the foot is referred to as plantar fasciopathy. The more commonly used term plantar fasciitis may not be the best label because –itis refers to an inflammatory injury and this appears to be more of a degenerative condition. The problem is usually that the foot is in pain from repeated overloading. This constant overloading in combination with a poor blood supply can make the recovery time very slow and individuals will often report pain for months to years.
What is the plantar fascia?
The plantar fascia is a band of connective tissue on the bottom of the foot that connects the heel to the toes. It works together with the small muscles on the bottom of the foot called the intrinsic muscles to help store energy and absorb shock during standing and walking. The plantar fascia is made of tightly packed collagen and is very strong in nature.
How does it get injured?
Despite its great strength, the plantar fascia is commonly injured. The main causes of plantar fasciopathy are caused from overuse and trauma to the bottom of the foot. Runners are one of the most commonly affected groups because of the repetitive force they put on the foot while running. People that overpronate, rolling their ankles inwards too much during walking, tend to have a greater risk of injuring the fascia as well. Other common risk factors include being overweight, having to stand for long periods of time on hard surfaces and wearing poorly fitted shoes.
What are the signs?
Individuals suffering from plantar fasciopathy typically feel a sharp pain in the bottom of the heel that is aggravated by weight bearing and relieved with rest. The first few steps after rest can be extremely painful and feel like a tearing sensation. If someone is feeling any numbness or tingling, it’s important to ensure that the nerves of the foot are not being irritated by any other structures.
There are countless treatment options available for plantar fasciopathy, but the goal for treatment is a combination of increasing strength and mobility through the foot and ankle, while decreasing the load going through the fascia. Firstly, soft tissue therapy helps to loosen up tight muscles and increases blood flow to speed up healing time. Joint mobilizations can help improve foot mechanics and decrease the load being put on the plantar fascia. Taping the foot can also aid in maintaining the proper tension in the plantar fascia and prevent the tearing feeling that people often experience. Another key to treatment is to strengthen specific muscles in the leg and foot that are in charge of maintaining the arch and absorbing the shock from weight bearing. If conservative treatment does not help, other options include getting orthotics to help support the foot, or a night splint to help keep the plantar fascia comfortably stretched. More recent research has also shown that shockwave therapy to the bottom of the heel can be very effective in treating plantar fasciopathy.