Foot pain affects nearly all people at one time or another. It can also lead to other musculoskeletal problems such as ankle, knee and back pain (Hill et al., 2008). This pain negatively affects one’s quality of life and ability to enjoy workouts and/or maintain a regular program of exercise. One of the most common sources of foot pain is plantar fasciitis, a condition where the connective tissue on the underside of the foot becomes irritated and painful as a result of an injury, overuse or misuse. The plantar fascia is a system of connective tissue that runs from your heel to just behind your toes. During weightbearing activities, such as walking or running, your body weight is transferred onto your foot from your heel to your toes (which results in your toes moving away from your heel). This spreading out of the foot places tension on the plantar fascia because it connects those two parts. If the tension on this structure is too great or is not dispersed evenly, the plantar fascia can develop microtears and become irritated and painful, resulting in a condition called plantar fasciitis.
When the foot moves, the plantar fascia stretches and contracts. Plantar fasciitis is caused by the repetitive overstretching of the plantar fascia. If the tension on the plantar fascia is too great, this overstretching causes small tears in the plantar fascia. This in turn causes the plantar fascia to become inflamed and painful. Factors that contribute to the development of plantar fasciitis include having very high arches or flat feet, gender, while anyone can develop plantar fasciitis, it tends to occur more commonly in women, exercises such as running, walking and dancing, particularly if the calf muscles are tight. Activities or occupations that involve walking or standing for long periods of time, particularly on hard surfaces, wearing high heeled shoes or shoes that do not offer adequate arch support and cushioning, being overweight, additional weight increases the tension on the plantar fascia, poor biomechanics, extra tension is placed on the plantar fascia if weight is not spread evenly when standing, walking or running. Some cases of plantar fasciitis may be linked to underlying diseases that cause arthritis, such as ankylosing spondylitis.
The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more rare problems, stress fractures, bone tumors-are contributing to your heel pain.
Non Surgical Treatment
There are several things you can do to self-treat your heel or arch pain. The first thing is to wear better shoes and consider adding arch supports or custom foot orthotics to your shoes. Stretching the calf muscles can also often be helpful. Try to stretch when you first get up in the morning and before you go to bed at night. Another good exercise is to “roll” your arch and heel. This is done by placing a tennis ball, golf ball, or lacrosse ball on the floor and rolling your foot on top of it. Some people get extra benefit by “rolling” on a frozen water bottle. You should also carefully evaluate your fitness program as you may be overdoing it. You may want consider backing of new or recently added exercises or increases in training until your heel pain improves. If you work at a standing job try to take more time to walk around during the day and avoid standing in one place for too long.
Surgery is not a common treatment for this condition. Approximately 5% of people with plantar fasciitis require surgery if non-surgical methods do not help to relieve pain within a year. The surgical procedure involves making an incision in the plantar fascia in order to decrease the tension of the ligament. Potential risks of this surgical procedure include irritation of the nerves around the heel, continued plantar fasciitis, heel or foot pain, infection, flattening of the arch, problems relating to the anesthetic.