Heel pain is a very common complaint and plantar fasciitis is the most common cause of chronic pain, comprising 11–15% of foot complaints requiring professional care among adults. In fact, recent research has reported that 1 in 10 people will develop plantar fasciitis during their lifetime. It is most common in middle-aged females and also with young male athletes with a higher incidence amongst the athletic population.
The plantar fascia is a tight band of non-elastic tissue that spans from your heel bone to the base of your toes. It functions to maintain the shape of your arch and control your foot during pronation (your foot collapsing inwards). Strain on the tissue from excessive and repetitive loading (as in long distance running) can create inflammation and pain will develop directly under the heel bone. The pain is greatest when the tissue is allowed to shorten, such as after long periods of rest or after a night’s sleep. Therefore, the first few steps when you get out of bed in the morning result in rapid lengthening of the plantar fascia tissue which is very painful and causes more inflammation and swelling. This initial pain generally subsides after several steps but will gradually increase throughout the day as you continue to walk and load the tissue.
Plantar fasciitis usually only involves one foot at a time, but up to 30% of cases involve both feet. Interestingly, tightness of Achilles tendon is found in almost 80% of plantar fasciitis cases. Thus, there are some basic treatment recommendations that must be followed to alleviate the pain and symptoms.
There are several devices that can help to stretch out the Achilles tendon and it is critical that improved flexibility of this tendon becomes part of your rehabilitation routine. Research has shown that it takes approximately 3-4 weeks for the Achilles tendon to begin to lengthen. You should stretch the Achilles tendon at least 2 times per day and perform at least 3-4 stretches of 30 seconds during each session. The best times to stretch are first thing in the morning to help lengthen the Achilles and the plantar fascia tissue and then stretch again just before you go to bed.
Two other methods that have been shown to be effective are braces and supports to help stabilize the arch of the foot and to decrease the amount of stretching to the plantar fascia. These arch support devices either wrap around the arch itself or they can also help to support the ankle joint. Because those first few steps are so painful first thing in the morning, another good option to reduce the pain is a Night Splint. The purpose of Night Splints is to prevent the plantar fascia from contracting over-night and to also promote Achilles stretching. The Splint keeps the ankle joint in a flexed position and holds the plantar fascia in an elongated position. A recent research study found that optimal treatment of plantar fasciitis consisted of Night Splints along with supportive shoes, anti-inflammatory drugs, and stretching.
Research from our lab, the Running Injury Clinic, has also shown that over-the-counter orthotics by SOLE reduce strain to the plantar fascia by 35%. These orthotics are considered semi-custom devices since you heat them up in the oven, place them in your shoes, and they mold to the shape of your foot. If you simply placed them in your shoes without heat-molding, plantar fascia strain is only reduced by 24% so we recommend going through the molding process to optimize foot care and comfort.
By incorporating SOLE insoles into a comprehensive rehabilitation program involving Achilles tendon stretching, Night Splints, and changing your exercise regime to reduce the amount of repetitive loading, hopefully you find your plantar fasciitis pain and symptoms improving quickly. If not, we recommend seeing a foot and ankle specialist (podiatrist) to discuss and confirm your condition.
Dr. Reed Ferber Ph.D., ATC
Director – Running Injury Clinic
Associate Professor, Faculty of Kinesiology, University of Calgary
The Running Injury Clinic is a world-leader in running-related research. Please visit our website at www.runninginjuryclinic.com for research concerning running injury prevention and treatment.