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Plantar Fascitis

By Michael DeChello, MS, PT

Plantar fascitis is the most common cause of heel pain. The plantar fascia is the thick tough connective tissue which runs from the heel to the base of the toes. The condition develops when this tissue becomes inflamed specifically where it attaches at the heel. The progressive pull of the tissue results in painful covering of the bone and the tissue itself. Over time this can cause micro tearing of the tissue. The tissue attempts to heal forming small areas of scar tissue. Each time the tissue is stretched it results in further tearing. This effect can lead to a chronic condition. The most common compliant is burning, stabbing or aching pain in the heel. Most often the symptoms are described by pain with the first few steps in the morning and/or after sitting for any length of time upon standing. The most commons causes of plantar fascitis are tight calf muscles and biomechanical abnormalities such as flat feet or high arches. As we age the resiliency of the tissue lessens making us more prone to this problem. Traditional physical therapy and conservative measures in most cases can help reduce the symptoms. These measures include modalities like ultrasound, electric stimulation, deep friction massage, stretching and iontophoresis. Anti inflammatory medication and local cortisone steroid injections may also be helpful. Controlling the symptoms is important however, addressing the underlining problem is the key to long term success. Proper stretching to maintain the flexibility of the tissue is vital and correcting the biomechanical abnormalities is also necessary. This can be achieved with proper fitting custom orthotics.

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