Plantar Fasciitis 101

by Dr Emily Splichal, DPM MS

Heel pain is one of the most common conditions treated by podiatrists, with an estimated 2 million Americans affected by plantar heel pain each year.  Of all the causes of heel pain, plantar fasciitis is the most frequently encountered diagnosis.  Despite its frequent diagnosis, commonly prescribed treatments can have negative side effects and do not always work.

This article will review plantar fascial anatomy, common causes of plantar fascial stress, how to identify plantar fasciitis and treatments recommended for plantar heel pain. 

Plantar Fascia Anatomy

The plantar fascia or aponeurosis is a thick band of tissue found on the bottom of the foot and consists of 3 bands: central, lateral, and medial, all of which are further divided into superficial and deep fibers.  The central band, which is the largest and most commonly stressed band, originates from the medial plantar aspect of the calcaneus and travels toward the toes as a solid band of tissue dividing into 5 slips, each of which inserts onto the base of each toe.
 
When the toes are flexed, such as when taking a step, the plantar fascia is stretched creating stability in the foot.  This stabilizing mechanism is referred to as the “windlass mechanism” and is how energy is transferred during the push-off phase of gait.
 
In many cases, plantar fasciitis is the result of excess or repetitive tensile stress which causes micro-tears and collagen changes in the plantar fascial fibers.  After being under stress for an extended period of time, the plantar fascia weakens and can become painful. 

Symptoms of Plantar Fasciitis

Patients with plantar fasciitis typically complain of heel pain.  This is usually located near the origin of the central band of the plantar fascia or at the medial aspect of the heel bone.  
 
Patients with plantar fasciitis also typically report pain first step in the morning or after a period of rest, which is referred to as post-static dyskinesia.  The pain will often subside with activity only to return toward the end of the day.  The pain is described as sharp or burning as is localized to the plantar surface of the heel.

How Do I Get Plantar Fasciitis?

• Having flat feet or very high arches
• Walking, standing, or running on hard surfaces for long periods of time
• Being overweight
• Having tight Achilles’ tendons or calf muscles
• Over-pronation
• Limited ankle mobility
• Certain auto-immune conditions

Treatment of Plantar Fasciitis

Plantar fasciitis can be very painful and should not be taken lightly.  If you avoid treatment in the early stages of plantar fasciitis it can lead to chronic changes in the tissue, leading to degeneration and tears. 

It is always recommended to seek care from a medical professional if experiencing heel pain.  The most common conservative treatment protocol includes NSAIDs or corticosteroid injections for the inflammation and pain, calf and plantar fascia stretching, custom-molded orthotics and night splints.  These conservative treatments can be effective, but can also have known negative side-effects.  NSAIDs and corticosteroid injections are not indicated for long-term use.

Your body is also very capable of healing itself. For those seeking alternative ways to support the body's natural healing function, an additional option is a supplement containing enzymes. Some enzymes, such as serrapeptase, bromelain and papain, have an immune-boosting benefit to help support the body’s inflammatory response. These ingredients have not been shown to have any serious long-term side effects.