1. What is it?
The plantar fascia is a band of fibrous tissue at the bottom of the foot extending from the heel to the ball of the foot. This structure plays a major role in supporting the arch and preventing the foot from collapsing under the weight of the body. When this structure is injured, it is generally an overuse injury resulting from micro tearing of the tissue.
2. What are the causes/predisposing factors of injury?
The causes of injury are varied and can be due to faulty foot biomechanics (overpronation or oversupination) or running too much on the toes due to increases in speedwork or hill training. Other causes can be running on hard surfaces and not enough cushioning in the shoes. I’ve even had cases where people have been shoveling during yard work, and the trauma of pressing down on the shovel has injured the plantar fascia; make sure you wear sturdy boots, not running shoes for this chore.
3. What are the symptoms?
This injury feels like a heel bruise and usually presents with tenderness along the bottom of the foot. A certain amount of swelling or even a small lump may be associated with the painful area. The hallmark sign of this injury is that the first steps out of bed in the morning are usually the most painful.
4. What can be done to prevent or treat this injury?
Prevention is targeted at stretching and strengthening the muscles in and around the foot and reducing the stress on the plantar fascia. Some good prevention routines involve calve muscle stretches and toe flexor and toe extensor strengthening exercises. Proper shoes, running on softer surfaces and gradual increases in speed and hill work are also preventative.
If you have this injury, run on softer surfaces in well cushioned shoes. Ice the area of pain regularly (3-5 times per day) for up to 10 minutes per application. I advise patients to get a 500mL plastic bottle of water, freeze it, and use the bottle to roll under the foot instead of using an ice pack. Rolling a golf ball under the foot while seated for 5 minutes twice a day can also be done.
If the injury persists, cut back your training and substitute non-weight bearing activities such as stationary bike and aqua jogging. Other therapies such as fascial strapping, ultrasound, soft tissue treatments, laser, anti inflammatory medication and foot orthotics to correct biomechanical problems can be used to treat this condition.