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Have you ever wanted to run a 5K?
Maybe a loved one asked you to run with them, perhaps you want to give back to your favorite charity, or maybe you are trying to get in shape.
So you go through the steps that every novice runner goes through.
You plan it into your schedule, break out the old running shoes, and hit the pavement for your first run.
However, this run is different.
Once you return, you start to get a dull pain in the bottom of your foot but, like many, decide to sleep it off.
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When you stand up the following day, the pain is worse.
It’s now a stabbing pain right in the bottom of your heel.
So, what happened?
Well, you may be experiencing plantar fasciitis!
What is the Plantar Fascia?
As with all musculoskeletal conditions, it is important to understand the anatomy of the affected body part.
The plantar fascia is the primary area where inflammation occurs in plantar fasciitis.
This structure is a strong, fibrous band of tissue that spans the length of the bottom of the foot.
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You may be wondering why it is called fascia rather than a ligament or a tendon.
The composition of fascia is similar to these structures, they are all made up of connective tissue like collage, but the functionality differs.
We know that the basic purpose is to provide stability to joints by connecting bones.
The basic goal is to connect muscles to bones allowing for joint movement when the muscles contract – but what is the function of fascia?
Fascia itself is a flexible structure that has elastic properties like tendons and ligaments.
This elasticity allows it to survive the forces and pressures applied to it so that when that force is removed, it can bounce back to its original shape.
The plantar fascia provides the foot with arch support by connecting the base of toes to the heel bone, or calcaneus.
This arch support is crucial when standing, walking, or running because these movements place the fascia under tension.
When you push off the ground with your toes, there is an increase in the tension in the plantar fascia – colloquially called the ‘spring in your step’!
What Causes Plantar Fasciitis?
While loading and unloading the plantar fascia is expected, a phenomenon called “creep” can develop if too much stress occurs to this structure over time.
This results from gradual but continuous strain applied to elastic tissues, leading the tissue to become stretched out.
How It Works
This concept is simple to understand if you can imagine an old and worn rubber band or hair elastic struggling to return to its original shape.
Fascia responds in a very similar way, and a number of factors can cause dysfunction.
Its usual capacity to disperse and diffuse stressful forces across the body can be impacted by a lack of movement, poor biomechanics, and damaging injuries.
Common Causes
- Plantar fasciitis can be caused by ‘creep’ leading to overuse and inflammation, but it can also be caused by acute injuries and strain to the surrounding structures.
- Athletes who run or jump on firm surfaces, like volleyball players or running on a treadmill, or more likely to develop plantar fasciitis because of the excessive strain to the plantar fascia.
- Standing for prolonged periods can also cause symptoms, especially if you are overweight.
- Lastly, poor gait biomechanics, pronation or supination, could be to blame for your plantar fasciitis.
The plantar fascia can be stretched through over-pronation (flat-foot), which results in repeated tension overload.
Individuals with over-supination (high-arched) absorb forces in the plantar fascia that are typically absorbed via other structures in the foot and ankle.
It was previously thought that the presence of a heel (calcaneal) spur was a cause of plantar fasciitis.
Still, it is now believed that they are not usually the cause rather the result of chronic tension being applied to the calcaneal attachment of the plantar fascia.
Getting Help with Plantar Fasciitis
Plantar fasciitis usually presents as gradually increasing heel pain but can also occur suddenly if it results from an acute injury.
Symptom Spotlight
The pain is often described as sharp or stabbing and runs along the bottom of the inside of the foot, from the heel to the big toe, or the medial longitudinal arch.
Because of its connection to the medial tuberosity of the calcaneus, pain may be localized to the medial heel.
Most patients will report that their discomfort is most noticeable after getting out of bed in the morning or after a period of inactivity.
Fortunately, plantar fasciitis can be diagnosed by a conservative care provider like a chiropractor, physical therapist, or osteopathic physician.
Most health care providers will evaluate your foot through a battery of tests.
These can include tests that attempt to recreate your painful symptoms.
In the case of plantar fasciitis, this means one of two things.
The first is your provider trying to elicit pain or tenderness by applying ‘passive tension’ to the big toe, meaning they push your big toe towards you.
The second is by using direct pressure to the bottom of your heel (the fascial insertions point) and recreating pain that radiates along the bottom of the foot.
Both of these tests and the history of the complaint are good indicators of plantar fasciitis.
The good news about plantar fasciitis is that getting an x-ray for an official diagnosis of plantar fasciitis is often unnecessary, which saves you both time and money!
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Over eighty percent of patients with plantar fasciitis improve within 12 months, regardless of the type of care they receive (1).
Many treatments for plantar fasciitis are widespread, including injectables for chronic plantar fasciitis sufferers and shockwave therapy.
There is limited but emerging evidence to guide the use of shockwave therapy for plantar fasciitis, with mixed results about its efficacy (2,3).
The use of injectable platelet-rich plasma (PRP) to treat persistent plantar fasciitis has some support in the literature (4,5).
The proposed theory is that the fluid contains elements for improved healing, but more research is needed.
More conservative treatments for managing plantar fasciitis do exist – and are more widely utilized.
Great News
A large majority of patients with plantar fasciitis respond to conservative care, especially chiropractic care.
Chiropractors are well-suited to manage plantar fasciitis if there are no underlying rheumatologic or other comorbid conditions.
Orthotics are recommended to correct biomechanical predilections like pronation or supination, determined by the frequency and degree of painful symptoms.
Having a conversation with your chiropractor can also provide you with advice about proper footwear.
Taping can be used to support the foot arches, specifically low-dye taping (6).
Myofascial release of the plantar fascia and surrounding soft-tissue structures may be beneficial for some patients.
Doctors of chiropractic can also manually adjust any restricted joints within the foot to improve mobility, particularly the navicular and first meta-tarsal phalangeal joints.
How You Can Manage Plantar Fasciitis
While these are all viable treatment options, there is always one thing patients want to know.
What can you do from home? Before you begin to self-manage this condition, it is important to see a healthcare provider and receive a formal diagnosis of plantar fasciitis.
If you have, here are some of the things you can do from home to help reduce your symptoms!
Strengthen
Strengthening the structures that support the Achilles tendon and plantar fascia can be pivotal in reducing symptoms over time.
Pro Tip
Try heel drop exercises.
These two structures work together to raise the arch and propel your foot off the ground while walking.
Ice
Ice massage is one of the most recommended home treatments for plantar fasciitis.
Not only does it provide symptom relief, but it helps reduce the inflammation in the fascia and stretches it at the same time!
Pro Tip
A common practice for those with plantar fasciitis is to freeze a plastic water bottle and roll the plantar fascia across it, from heel to toe.
Here’s a video to help you get started.
If an ice massage is too intense, try using an ice pack covered in a thin cloth for fifteen minutes each day.
Stretch
The plantar fascia, Achilles tendon, and calf muscles may all be stretched through simple yet effective exercises that you can do from home.
Pro Tip
We recommend this plantar fascia stretch.
Because lack of ankle dorsiflexion is a risk factor for plantar fasciitis, previous stretching methods focused on lengthening the Achilles tendon.
Specifically, stretching the plantar fascia, however, is more beneficial.