Heel Pain in the morning? Plantar fasciitis

Plantar fasciitis is a common foot condition that affects one in ten adults during their lifetime. Similar to carpal tunnel syndrome or tennis elbow, plantar fasciitis is an overuse injury that results from wear-and-tear. The arch of the foot is supported by a thick band of tissue called plantar fascia that spans from the heel to the toes. Tension in the plantar fascia holds the shape of the arch, stretching each time you take a step. When stretched too hard and/or too often the fascia can become irritated and for most people causes pain in the heel of the foot while others feel it in the arch. A diagnosis of plantar fasciitis means that there is either chronic inflammation to the fascia or micro-tearing. With proper arch support (inserts or different shoes), rest and stretching most people are able to bounce back. Plantar fasciitis can be stubborn for others, making it difficult to return to their usual activity level, and in some cases other symptoms may develop in the foot, knee, hip, or back because the pain causes them to walk differently.

Signs and Symptoms 

The hallmark sign of plantar fasciitis is heel pain first thing in the morning, typically in the first 10 steps of the day. It is usually accompanied by tightness in the calf. In many cases the pain is initially only felt in the front of the heel on the big toe side of the foot, but without treatment it may eventually spread to the arch and even the ball of the foot.

Factors

Plantar fasciitis affects people of all ages, both athletes and non-athletes. Men and women have an equal chance of developing the condition. Factors that contribute to the development of plantar fasciitis include: 

• Age Being between the age of 40 and 60 
• Occupation Work that requires prolonged periods of standing or walking (e.g. factory workers, teachers, cashiers, servers) 
• Foot Mechanics Flat feet (pronation), high arches, or abnormal gait patterns 
• Obesity A Body Mass Index greater than 30 
• Exercise Certain types of activities that place stress on the foot (e.g. long-distance running, ballet dancing) 
• Lifestyle Change Rapid increases in length, level, and/or type of activity (e.g. runners that increase mileage too quickly, rapidly adding more weight or excessive jumping during workouts, job change from sitting to standing) 
• Footwear Wearing improper footwear such as shoes without arch support, flip-flops, or high-heels

Physical Therapy for Plantar Fasciitis

When treating patients with plantar fasciitis we start by evaluating factors that may be contributing from biomechanical imbalances to lifestyle. We like to educate the patient as much as possible if there are any lifestyle changes they can make to decrease symptoms including recommending orthotics when appropriate. Our treatment sessions are designed using a variety of techniques, exercises, stretches, and equipment based on each individual case and may include: 

• Stretching to improve the flexibility of your ankle, calf, and the plantar fascia 
• Pilates to work on ankle proprioception, mobility and articulation as well as challenging balance and ankle stability 
• ASTYM® (A-stim) to regenerate healthy soft tissues (muscles, tendons, etc.), and remove unwanted scar tissue that may be causing pain or movement restrictions, generally found in the calf and plantar fascia 
• Trigger Point Dry Needling and Massage Therapy to release shortened bands of muscle tissue known as trigger points, improving flexibility and increase range of motion 
• Strength to activate muscles, generally in the calf, hamstrings and glutes 
• Use of a splint to maintain correct ankle and toe positions while sleeping 
• Changing footwear and/or shoe inserts to minimize foot pronation, support arches, and reduce stress to the plantar fascia 
• Icing to decrease pain and inflammation 
• Taping to provide support and decrease pain

It will take time for your fascia to fully recover and your foot pain to fade away. But with an individualized treatment plan, home routine of daily stretches and exercises, proper shoes and other recommendations, the healing will go faster and you'll be back to the activities you love. Get the help of one of our physical therapists to find which treatments are a fit for your feet.