Everything You Need to Know About Plantar Fasciitis

Everything You Need to Know About Plantar Fasciitis

Everything You Need to Know About Plantar Fasciitis

Most athletes, whether they’re serious about training or occasionally take part in sports, will experience their share of injuries. Runners especially suffer from foot injuries. Perhaps none are more troubling than plantar fasciitis. Although this is a fairly common foot injury, affecting approximately 10 percent of all those who run, the real cause of this condition is still not entirely agreed upon and treatment remains difficult. The following information describes what plantar fasciitis is, how the condition can be diagnosed, and ways to relieve the pain.

What is Plantar Fasciitis?

Plantar fasciitis occurs when the support system along the bottom of the foot becomes irritated. This will result in pain at the very bottom of the foot and heel. Professionals are not in agreement on whether the condition is caused by ongoing inflammation or continued trauma that brings about weakened tissues and chronic degeneration.

Many people who develop this condition spend long hours on their feet, whether it’s because of their occupation or participation in athletics. When an individual is running the plantar fascia works in conjunction with the Achilles tendon. Due to the strong attachment at the base of the toe, the plantar fascia will help stabilize the inner part of the foot. Plantar fasciitis will usually be painful when the foot pushes off while running, but not when there is initial contact. This makes this injury different from other heel conditions such as stress fractures and bone spurs.

What Causes Plantar Fasciitis?

This condition may be the result of a combination of factors, some of which include continually running hill workouts or even tight calves. Several specialists believe, however, that the biggest cause is fallen arches.

This can happen when flat-footed runners excessively lower their arches and thus the tension increases in the plantar fascia. This in turn overloads the attachment in the plantar fascia onto the heal bone. Over the course of time the plantar fascia being subjected to repeated pulling is believed to lead to inflammation and chronic pain where the plantar fascia connects to the heel.

How is Plantar Fasciitis Diagnosed

There are different ways for how plantar fasciitis is diagnosed. One way to tell if you’re suffering from plantar fasciitis as opposed to a stress fracture or heel spur is to walk on your toes. Stress fractures and spurs in the heel will normally feel better when you’re on your toes. Plantar fasciitis will usually cause more discomfort when you put weight on your toes.

Once a person has been diagnosed with plantar fasciitis it’s important to take precautions so the condition does not worsen while treatment is being sought. Since the plantar fascia receives the most stress during the propulsive time while running, those with plantar fasciitis should not make initial ground contact with their forefoot or the middle of their foot. A striking pattern with the heel first is the best contact point. A runner should also avoid hill running until this type of injury has been resolved.

How to Relieve Plantar Fasciitis Pain

While icing and using anti-inflammatories can temporarily relieve the pain of plantar fasciitis, it is not a permanent treatment. The following provides several examples of treatment options for plantar fasciitis.

1) Individuals who complain of excessive pain during the morning hours have had good results using night braces. Soft tissues that are immobile and in a lengthened position usually will heal more quickly. It’s sometimes recommended to place a small cloth that is rolled up under the toes while the night brace is on. The cloth should be placed in a way so it does not add to any discomfort.

2) Physical Medicine and Rehabilitation recently published a review article that stated that the best treatment involves stretching the calf and the plantar fascia itself. The article also suggests treatment arch support. Foot orthotics are sometimes recommended as treatment for these types of foot conditions. The research suggested that arch support worked best when combined with a certain amount of stretching.

3) A study published in the British Journal of Sports Medicine in 2013 states that foot core strengthening can be used for treating plantar fasciitis. The article goes on to say that while using arch support can be helpful during the initial phase of the injury, it should be replaced as quickly as possible with a strengthening routine.

4) Placing angled wedges under the inner heel is another way to manage plantar fasciitis. Research at the Orthopedic Bioengineering Research Laboratory located in Illinois has shown that an angled wedge under the inner heel significantly reduced the strain when the full body weight was placed on the foot. These types of wedges are available that can be put beneath the insole of a shoe.

5) For those who don’t respond to any of the previous treatment methods some have had success with extracorporeal shock wave therapy. This treatment can be completed in an office setting by sports podiatrists. It is believed to stimulate repair of the damaged area and bring about faster healing. Most individuals who suffer from plantar fasciitis, however, normally respond well to less expensive treatments that can be completed at home.

What Types of Treatment Have Been Proven Ineffective?

Some people might want to try corticosteroid injections to relieve the pain from plantar fasciitis. These types of injections should be avoided since this will increase the chance of rupturing the plantar fascia or even causing damage to the protective fat pad on the heel.

Surgical intervention should always be used as an absolute last resort. This is because the cutting of the plantar fascia will result in the slow destruction of the medial arch. Because the plantar fascia plays an important role in stabilizing the arch, if it is surgically cut the arch will eventually collapse. Instead of using injections or cutting the plantar fascia a better solution is to try deep tissue massage to both the calf and the arch.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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