Plantar Fasciitis
Plantar fasciitis is inflammation of the plantar fascia which is a ligament that makes up the arch of the foot. It is often caused by overuse of the plantar fascia or arch tendon of the foot. Pain occurs from small microscopic tears in the ligament that causes pain and stiffness in the heel from standing and walking on hard surfaces.

The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. It is also known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.



Symptoms
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Symptoms of the plantar fasciitis include pain under the heel and usually on the inside, at the origin of the attachment of the fascia. There can be pain when pressing on the inside of the heel and sometimes along the arch. The pain is usually worse first thing in the morning as the fascia tightens up overnight and after a few minutes it eases as the foot gets warmed up.

As the condition becomes more severe the pain can get worse throughout the day if activity continues. Stretching the plantar fascia may be painful and sometimes there may also be pain along the outside border of the heel. This may occur due to offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.

Tarsal tunnel syndrome symptoms can be very similar. If you have any shooting pain or tingling / numbness then consider this as an alternative diagnosis.

Treatment
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Although there is no single cure, many treatments can be used to ease pain. In order to treat it effectively for the long-term, the cause of the condition must be corrected.

What can the athlete do?
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• Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation.
• A good plantar fasciitis taping technique can help support the foot relieving pain and helping it rest.
• Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved.
• Plantar fasciitis exercises in particular stretching the fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The fascia tightens up making the origin at the heel more susceptible to stress.
• A night splint is an excellent product which is worn overnight and gently stretches the calf muscles preventing it from tightening up overnight.

What can a Sports Injury Professional do?
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• Prescribe anti-inflammatory medication such as ibuprofen
• Perform gait analysis to determine if you overpronate or oversupinate and prescribe orthotics or insoles. An insole can restore normal foot biomechanics if overpronation is a problem.
• Tape the foot and instruct the athlete how to apply taping, this is an excellent way of allowing the foot to rest.
• Apply sports massage techniques to reduce the tension and also stretch the calf muscles.
• Prescribe exercises to help stretch the fascia and strengthen it once pain free.
• Use a corticosteroid injection - usually best combined with biomechanical correction with orthotics.
• X ray to see if there is any bone growth (calcification). An X-ray may be able to show bone growth which may be a cause of pain but research has shown that the presence of a bony growth does not necessarily mean the athlete will feel pain. Bony growth can worsen even after symptoms have completely resolved.
• Use Extracorporeal Shock Wave Therapy.
• Operate if symptoms do not resolve. This is more common for patients with a rigid high arch where the plantar fascia has shortened to benefit from surgery.