How to manage plantar fasciitis

What is plantar fasciitis and what can I do about it?

Plantar fasciitis is one of the most common causes of heel pain and will affect 10% of people over a lifetime. It involves pain and inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes, called the plantar fascia. It is often a result of overuse injuries, an increase in exercise or an increase in weight. It is most painful the first steps after a period of rest and most commonly affects runners, individuals with tight calf muscles or individuals with fallen arches/flat feet.

While running or walking, the plantar fascia works with the Achilles tendon to store and return energy and also stabilizes the inside of the foot during push off of the gait cycle. Unlike bone spurs and stress fractures of the heel, plantar fasciitis tends to produce pain during the push off phase while running or walking, not during initial contact. One way to tell if you have plantar fasciitis versus a heel spur/stress fracture is to walk on your toes: heel spurs and heel stress fractures feel better while you walk on your toes, while plantar fasciitis typically produces more discomfort when you shift your weight onto your toes. Because the treatment protocols for plantar fasciitis and heel spur syndrome are different, it is important to first consult your local health care provider to diagnose these two conditions correctly.

Plantar fasciitis is often treated with orthotics, stretching of the plantar fascia and calf muscles and strengthening of the intrinsic foot muscles, specifically the flexor digitorum brevis. Heel spur syndrome is often treated with pocket accommodations, heel cups and well-fitting heel counters. Cortisone injections should be avoided because of an increased risk of rupturing the plantar fascia and/or damaging the heel’s protective fat pad. Because surgery to cut the plantar fascia results in a gradual destruction of the inside arch (the plantar fascia is an important stabilizer of the arch and when it is surgically cut, the arch eventually collapses), surgical intervention should always be a last resort.

At home therapy for plantar fasciitis consists of strengthening the foot muscles and stretching the plantar fascia and/or rolling the plantar fascia over a golf ball. It is also important to reduce your stride length and increase your cadence while waiting for the plantar fascial injury to resolve.

As with the majority of mechanical musculoskeletal conditions, treatment interventions emphasizing manual therapy, orthotics, stretches, and rehabilitative exercises almost always outperform popular pharmacological interventions such as NSAIDs and corticosteroid injections.

Middle Tennessee Chiropractic and Sports Injury, PLLC is dedicated to helping patients achieve optimal health by providing a patient-centered treatment approach for individuals of all ages.