Plantar fasciitis is one of the most common foot problems causing pain on the sole of the foot near the heel. This condition alone results in approximately two million visits to both foot specialist and primary care physicians each year. The condition is caused by inflammation of a thick band of tissue that runs along the bottom of the heel to the toes.

There are several factors that have been suggested that cause this condition:

1. Obesity
2. Occupation: There is a correlation between plantar heel pain and sudden changes in stress placed on the feet or prolonged walking or standing.
3. Injury: An acute injury to the heel such as stepping on a hard object before the pain started.
4. Anatomical: A loss of elasticity in the heel pad has been linked to be a factor in plantar heel pain.
5. Biomechanical: People with high or low arches are at increased risk because there is increased stressed being placed on the plantar fascia.
6. Calcaneal (heel bone) Stress Fracture: Seen in a sudden increase in running activities, such as boot camp.
7. Weak intrinsic foot muscles

Signs and symptoms

• Reports of pain and tenderness where the arch of the foot connects to the heel, especially during the first weight bearing steps in the morning or after a period of inactivity. It is thought that the plantar fascia becomes stiff at night because when we sleep, we naturally point our toes downward, which shortens the plantar fascia. Then, when we take that first step in the morning the stiffness developed overnight on the sole of the foot causes pain

• The pain felt in the heel decreases during the day but increases with activity, such as running, walking up the stairs, or raising up on toes

• Slight swelling in the area and tenderness to touch is common

• A tight Achilles tendon

Interventions

Manual therapy: Performed by a physical therapist for joint and soft tissue mobilization to loosen the area of the calf and ankle and to decrease pain.

Stretching: Plantar fascia specific and gastrocnemius/soleus (calf) stretching.

Taping: A physical therapist can tape the foot to relieve plantar heel pain.

Foot orthoses: A custom or over the counter foot orthoses can be used to reduce pain.

Night splints: A clinician can prescribe a night splint to keep the foot from naturally plantarflexing (toes point down) at night to prevent pain with first steps in the morning.

Sources:
Dutton M. Dutton's Orthopaedic Examination Evaluation and Intervention. 4th ed. New York: McGraw-Hill Medical; 2017.
Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44(11):A1-33. doi:10.2519/jospt.2014.0303

Dara Ching is a competitive Olympic weightlifter and Crossfit athlete. She started competing in Olympic weightlifting in 2004, and since, has competed in numerous USAW National and American Open Championships. Dara has been competing in Crossfit competitions since 2011. She is a six time regional level Crossfit competitor. Dara is also a Navy Veteran, who served as a Naval Flight Officer. Currently, Dara is pursuing a doctorate in physical therapy at the University of St. Augustine for Health and Sciences, where she graduates in April.