Stepping out of bed one morning, I felt a sharp pain at my heel as I planted my left foot on the ground. I hopped to the bathroom, wondering what had happened to my foot. Had I stepped on a nail or rock without noticing? It felt as if my heel bone was bruised. As the day went on, I cautiously continued to walk on it and I noticed it felt better. However, the next morning I woke to find the same problem. If you’re experiencing something similar, you might have plantar fasciitis. Come visit us at SEMI and let’s get to the bottom of your foot pain!
What is plantar fasciitis?
Let’s begin with the structures involved. The plantar fascia is a thick fibrous band of tissue originating on the bottom surface of the heel bone (calcaneus) that spreads out, inserting to the base of your toes. The calf muscles (gastrocnemius and soleus) attach to the back of the heel bone via the achilles tendon, and can contribute to the symptoms of plantar fasciitis. The calf and plantar fascia work together to propel you forward when you’re walking or running. The calf muscles provide a contractile element of propulsion, while the plantar fascia acts like a “loaded spring” as it is stretched in the early phase to mid phase of propulsion. Next time you take a walk, or even just a few steps, think about these structures as work – our bodies are quite incredible!
Plantar fasciitis results from excessive stress on the plantar fascia, which can be caused by several factors:
- a lack of flexibility of the plantar fascia and/or the calf muscles (gastrocnemius/soleus)
- weakness in the muscles of the foot or ankle
- increases in weight bearing forces (weight gain or increased weight bearing activities)
- poor proprioception (balance sense) or structural foot deformity
Plantar fasciitis pain occurs due to pulling on the outer layer (periosteum) of the heel bone, which is rich in nerve endings. Often there is a bony growth (bone spur) associated with this diagnosis if it has been present for a prolonged length of time. The symptoms are caused by tension on the bone, not by the bone spur itself. The bone spur forms due to the tension on the bone which causes the growth.
- Heel pain at the origin of the plantar fascia (the bottom surface of the heel) when weight is put on the foot or when standing on tip toes. Tenderness and swelling may occur under the heel, or you may experience numbness along the outside of the sole of the foot.
- Pain is usually worse first thing in the morning or upon rising after a long period of non-weightbearing due to what is known as “physiological creep.” Physiological creep is defined as the gradual shortening of tissue over a period of time. After a few minutes of weight-bearing it eases as the foot gets warmed up, but can get worse again during the day especially after walking a lot. During the night as the foot is relaxed in a plantar flexed position, the plantar fascia becomes shortened. Pain is increased on initial weight bearing due to greater tension pulling at the origin of the plantar fascia.
What can YOU do?
- Get a diagnosis. While plantar fasciitis is common, there are other problems that can mimic this condition.
- Treatment can include many forms of therapy, orthotic presription, night splints, cortisone injections, shockwave therapy, and surgery in stubborn cases.
Keeping the muscles and joints of the legs and feet flexible and strong will help prevent this type of injury. This involves regular stretching and exercise of the calf muscles and plantar fascia. Proper warm up and cool down and appropriate footwear choices when active are also important in prevention.
Sports & Exercise Medicine Institute is the leading sports medicine, physiotherapy, and chiropractic clinic in the Greater Toronto Area. We offer expert diagnoses, a variety of treatment options, and high-quality care. Click here to learn more about the services we offer, or contact us to schedule an appointment.