Do you wake up in the morning, step out of bed, and get pain in your heel? You could have plantar fasciitis (pronounced fashee-EYE-tiss). Plantar fasciitis is an inflammation of the tough, fibrous band of tissue (fascia) that connects the calcaneous (heel bone) to the base of your toes. I know firsthand what that pain is, since I suffered from plantar fasciitis during my college volleyball career. Doctors tried injecting cortisone, which did not work, but they never suggested physical therapy since they assumed I was getting that in the training room. Now that I am a physical therapist, I know how plantar fasciitis should be treated.
First, it is important to understand the mechanics of the problem. Plantar fasciitis occurs when the plantar fascia is shortened. If the force of the gastroc/soleus muscle complex is pulling the heel bone one direction and the plantar fascia is pulling the calcaneous in the opposite direction, pain in the heel occurs. The plantar fascia may also become tightened if it is trying to support the medial arch of the foot, due to an unusually high arch or a flat foot.
After describing why the pain is in the heel, I think you should be able to recognize the signs and symptoms. As mentioned earlier, pain in your heel in the early morning, after exercise, or when walking is an obvious symptom. Tight gastrocnemius and soleus muscles (calf muscles) is another. Painful palpation of the calcaneal tubercles, medially and/or laterally, is a positive diagnostic sign for physical therapists. Decreased dorsiflexion of the ankle is usually present, because the calf muscles are so tight. Lastly, the actual plantar fascia is a tight cord and painful with soft tissue mobilization.
The treatment of plantar fasciitis is varied, depending upon the approach of your doctor or podiatrist. Some doctors start by asking you to rest your feet by ceasing your exercise routine. Others might offer cortisone injections, acupuncture or physical therapy. Some might just give you a prescription for an anti-inflammatory.
Physical therapy is an important component in my rehabilitation that was sorely missed. Physical therapists normally massage the plantar fascia and the tight gastrocnemius and soleus muscles to gain length in the shortened tissues. Next, patients are taught to stretch their calf muscles and plantar fascia appropriately. It is important to hold the stretch with a straight knee (gastrocnemius muscle) for 30 seconds and a bent knee (soleus muscle) for 30 seconds. The downward dog yoga stretch works well. In addition, the therapist might prescribe some theraband exercises to strengthen the tendons that support the arch of the foot. Lastly, the patient will be advised to roll onto a wooden dowel or frozen water bottle to maintain the increased length of the plantar fascia that is achieved through the physical therapist’s soft tissue mobilization.
If you think you might have plantar fasciitis, sign up for a free injury check at BaySport and the physical therapists can help you get rid of this dreaded heel pain!
Written by: Laurie Quinn, P.T.