Plantar fasciitis is the most common cause of heel pain among athletes. Pain on the bottom of the heel, most prominent with the first steps that one takes in the morning, is the classic sign of this condition. Pain also occurs with the onset of activity such as walking and running. This pain may decrease as activity progresses, but it usually returns after resting and then resuming activity. In severe cases, the pain may occur with any weight bearing. Although the pain usually occurs in the heel, it can radiate throughout the bottom of the foot towards the toes.

Considered a chronic inflammatory condition rather than an acute injury, plantar fasciitis is common in runners and dancers who use repetitive plantar flexion of the ankle (pointing the toes). It is also common in those who experience sudden weight gain and in overweight individuals who increase their activity level too quickly.

Anatomy: The plantar fascia is a dense band of tissue that originates from the back of the heel and fans out from there to the base of the toes. The plantar fascia provides support for the arch of the foot. Shortly after heel strike of walking or running, the arch will collapse down causing a stretch of the plantar fascia as the foot flattens. Since the fascia has no elastic properties, repetitive stretching results in micro tears at the heel.

Typical morning pain is caused by the foot resting in a toe pointing position during the night, allowing the fascia to contract. With the first few steps of the day, the irritated fascia is stretched, resulting in a significant amount of pain. This will last only for a few steps, but will progressively loosen up as more steps are taken.

Plantar fasciitis has been found to be more common in middle-aged women and young male runners. In the US, studies have shown that obesity is present in 90% of affected females and 40% of affected males.

History:
• Heel pain, which is worse with the first steps in the morning.
• Pain may be noted at the beginning of exercise and when weight bearing is resumed after resting.
• The pain is dull and is similar to that of a toothache.
• The patient may have a history of recent weight gain or a sudden change in exercise pattern (i.e. longer distance, harder surface, change in shoe, etc.).

Contributing Factors:
• Flat (pronated) feet
• High arched rigid feet
• Inappropriate/improper footwear/skates
• Toe running/hill running
• Soft terrain (i.e. running on sand)

Treatment of Plantar Fasciitis:
1. Rest (Use pain as your guide, weight-bearing sports can be temporarily replaced by swimming and/or cycling)
2. Ice – 15-20 minutes (usually following activity)
3. Warm water bottle rolling (fill an old Coke/Wine bottle with warm water and roll underneath foot for 3-5 minutes)
4. Medication - Anti-inflammatory pills (as prescribed by your doctor)
5. Athletic therapy/Physiotherapy- Stretch and strengthening of the small muscles of the foot to support the plantar fascia. Stretching of the calf muscles will also alleviate some tightness.
6. Acupuncture
7. Active Release Techniques
8. Cortisone shot
9. Surgery (rarely required)
10. Night splint as prescribed by a medical professional
11. Orthotics