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What is Plantar fasciitis?

ask-the-doctorPlantar fasciitis is a common cause of foot and heel pain. Typically this pain is located on the bottom of the foot just in front of the heel pad on the inner or middle side of the foot. The plantar fascia is a thick tendon that connects the heel bones to the toes. This tendon serves as a shock absorber for the foot and helps in supporting the arch of the foot. Overuse or excessive stress on this tendon can cause small tears that lead to inflammation and significant pain.
 
Some common risk factors for plantar fasciitis include:
-Obesity
-Poor foot mechanics
-Improper shoe wear
-Long distance running
-Jumping exercises
-Prolonged standing
 
In MAX we have a fair amount of jumping or plyometric exercises that are very good for cardiac conditioning and development of muscle power. Generally speaking the heart muscle gets conditioned faster then skeletal muscle. Therefore, your skeletal muscles will fatigue more quickly and your form will break down before you get “exhausted” due to deconditioning from the heart.
 
There are muscles on both sides of the foot and leg that help to support the foot and ankle. The peroneus longus and peroneus brevis insert on the outermost or 5th metatarsal (mid bones of the foot) and the tibialis anterior inserts on the inner or 1st metatarsal bone. When these muscles are strong and conditioned, they help with stabilizing lateral (side-to-side) foot motion and control the rate of movement in the foot during jumping exercises. If however, these muscles fatigue quickly or are not yet strong, the foot and ankle has more mobility and collapse in the arch, which in turn can put more strain on the plantar fascia.
 
This is one of the reasons that plantar fasciitis typically develops in an exerciser after several weeks or months of exercise. It generally occurs when the aerobic or cardiac conditioning out paces the skeletal muscle conditioning. In other words, your heart endurance allows you to jump or run for longer periods of time, but your leg muscles are not conditioned enough to control your ankle motion. If in addition to decreased muscle strength, you are carrying around extra weight, are wearing improper shoes, have poor foot mechanics or are increasing the amount of time or the intensity of your jumping, you are a set up for plantar fasciitis.
 
So what should you do?
 
It is important to know what type of foot you have and have the proper shoe wear before embarking on exercise and lifestyle changes. There are several very good running stores and even some online stores which will question you about your feet and recommend proper shoe wear. Podiatrist or Sports Medicine/Rehabilitation Medicine physicians are also useful for providing recommendations and treatment plans. It is important to note that not one type of sneaker is good for everyone. Sometimes due to foot or even hip and knee mechanics you will need an orthotic insert to place in your shoe.
 
In general, a helpful guideline for shoe wear and orthotic use is to fix what is too flexible (i.e put in arch support in a very flat foot or over-pronating foot) and to accommodate foot deformities that are fixed (i.e. relief or padding around bony deformities such as bunions). A common mistake is to over correct too much (using too rigid or too high an arch support). This can lead to other issues higher up the kinetic chain such as knee, hip or back issues.
 
Plantar Fasciitis is typically worst in the morning just after getting out of bed. Pain is usually severe with initial weight bearing and then subsides throughout the day with walking and weight-bearing. Pain can also be severe after prolonged sitting or immobility. It is often helpful to wear nighttime splints to keep the foot/Achilles tendon stretched out overnight. This will decrease the initial severe morning pain because the fascia will have more mobility and will not be able to “scar down” overnight.
 
Aside from using proper shoe wear and night time splints, occasional use of anti-inflammatory medications such as Motrin will be helpful. Adding anti-inflammatory foods such as turmeric, (curcumin), boswellia, and Omega-3 fatty acids in addition to decreasing intake of Omega-6 fatty acids may also be helpful. Icing can be helpful as well. Sometimes, despite the above interventions, you will might need a cortisone injection into the plantar fascia to decrease inflammation and pain.
 
During the acute inflammatory phase of plantar fasciitis, it is important to limit the activities such as high impact jumping and running that can aggravate the condition. Modify your exercise to limit jumping until pain resolves during activity and upon wakening. As pain decreases is it imperative to resume jumping/high-impact exercises slowly over a period of weeks to even months to prevent recurrence. As with all my recommendations, if you have persistent heel pain that is refractory it is important to seek the advice of a medical professional to make sure other modifications or treatments are indicated.
 
Disclaimer. The information provided here is not intended to substitute for medical care and should not be used for treatment or diagnosis. If you have, or suspect you have a problem concerning your health please consult with a licensed healthcare professional.
Article written by Dr. Jessica Miller
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