Plantar Fasciitis: Important Treatments for Those who Suffer

plantar fasciitis

While there is a wide range of sports related injuries, one of the most common relates to the relationship between the heel, ankle, and foot, due to its complicated mechanics. Podiatrists often see both athletes and everyday sedentary people with the complaint of heel pain. Sports that use cleated shoes, such as football and soccer, are often to blame. However, plantar fasciitis can happen to anyone, due to its multitude of risk factors. There has been a rise in the incidents of plantar fasciitis in recent years, likely due to the fact that it is most common in people between 40 and 60, which is also the highest population demographic of the United States. At this age, people are still active, but their tendons and tissues are becoming worn.

Subcalcaneal pain syndrome, also known as plantar fasciitis, causes sharp pain in the heel while engaging the foot. This pain is caused by the plantar fascia becoming inflamed. This can be due to repetitive stress, overuse, overstretching, or bruising. Plantar fasciitis may also be associated with heel spurs, although having a heel spur does not make plantar fasciitis inevitable.

The plantar fascia is the mold that keeps the foot together. It consists of connective tissue that runs from the bottom of the heel to the ball of the foot. It helps to keep the joints and bones of the foot in place, and helps you have leverage of the ball of your foot. Athletes use this to make quick movements, pivots, change direction, and to accelerate into motion.

Overall, the best treatment for this ailment is rest. This gives the fascia time to reduce its inflammation and return to normal function. However, it may be difficult for athletes to take time away from their sport to rest. Due to time constraints, it has been recommended that athletes treat their plantar fasciitis a bit differently than others who are not typically active in sports.

Risk Factors

There are many risk factors that contribute to plantar fasciitis, both sports related and otherwise. Here are some plantar fasciitis causes.


Weight bearing down on the mechanics of the heel and foot is increasingly harmful as it rises. In addition to the added pressure of pounds on the body, inactivity can create a chemical damage in the band of the sole of the foot, which damages the area and increases pain. This chemical damage occurs when a strong vertical force is caused by being overweight, resulting in an increase of stress on the tissues of the foot.

Football players tend to be very muscular, which adds weight to their body, increasing their BMI. While they are considered to be “obese” by the terms of the BMI chart created by the World Health Organization, they typically just have a lot of mass for their height, due to their profession. However, this excess weight causes plantar fasciitis to often occur in football players.

While football players and other sports professionals do not have the option to lose weight, it is likely to help nonathletes in the treatment of plantar fasciitis.

Specific Sports

Sports requiring quick change of movement or a rapid change in direction are more likely to cause plantar fasciitis than less active sports. Jumping and pivoting put pressure on the bottom of the foot, which is likely to stretch and injure the fascia. Alternatively, sports like swimming and golf don’t require this type of movement, and are therefore less likely to cause harm.

Pivoting and cutting directions in fast-paced sports like lacrosse, field hockey, and football put extra pressure under the arch of the foot and the heel than simple running. Plantar fasciitis in football players, for example, can occur when players use the ball of the foot to push off to accelerate. This stretches the bands and ligaments, putting them at the risk of being torn. This hazard creates a need to keep the foot balanced while playing these sports.

Wearing Cleats

Cleats have poor arch support and flat soles, which can contribute to plantar fasciitis. Cleats are created to fit like a glove. They are lightweight and flexible, molding to the foot. Sports professionals have three choices for the benefit that their cleats give them. These are speed, technique, and accuracy. Choosing the correct type of cleat for the ultimate goal is important, and should be taken into consideration more than the attractive appearance of a product.

Athletes often find that tight cleats confine their feet, which may feel uncomfortable. This is important, however, to improve an athlete’s balance by giving a larger area of ground contact vs. bare feet. A strong factor in orthotic health is the volume and cushion of a shoe, which the cleat typically lacks. A good cleat comes with removable insoles, so the player can adjust them as needed for comfort.

Cleats are not designed to keep the band of the foot from straining. Their purpose requires them to have hard plastic soles, which results in the continuous pounding of a flat surface on a part of the body that is meant to have more support.

Biomechanics and Warm Up

Without a proper warm up, a sudden acceleration or change in direction can stretch and damage the bands in the sole of the foot. Impacting the windlass mechanism in the foot at a high speed is a common maneuver for athletes, and should not be done without a warm up.

Preventing injuries such as plantar fasciitis is why professional athletes often spend long periods of time warming up before a game. Stretching muscles, keeping the body activated, and making sure the body is not stiff or tight plays a big role in reducing the occurrence of injuries. Stretching and warming up helps to keep tissues and muscles loose. Having a proper warm-up prior to participating in a sport is associated with better performance and a lower rate of injury.

Even a ten minute warm up of light running before playing sports to get blood flowing through the body can enhance the development of force in and around the ankle and heel, which can help to prevent injury.

Signs and Symptoms

While the cause of heel pain may be initially unknown, here are some signs and symptoms of plantar fasciitis that are common in both athletes and sedentary individuals.


Pain typically appears on the lower end of the heel. It is often the most intense during the first steps of the day or after a period of rest. After a long period of having no weight beared on the heel and then having a sudden change of stress, the pain is typically initiated.

Sharp pain may occur on the bottom of the heel, closer to the middle of the foot, which may be as sharp as a stabbing sensation. This pain not only increases during the first few steps after a rest, but also when going up stairs or standing on toes. The pain also intensifies more so after a workout is complete, rather than when it is in progress.


The heel may also experience swelling. As the connective band in the foot becomes irritated and begins to swell, it may swell to the point that it is visible from the outside of the foot. This swelling with come and go with the level of activity being performed. Athletes with plantar fasciitis may notice their shoes become a bit tight if they do experience this swelling.

Treatment of Plantar Fasciitis

For most sufferers, this condition is able to heal on its own within a year. However, treatments can help to speed up this process. Athletes want to quickly return to their activity to minimize their loss of performance and fitness. This adds pressure on both the sufferer and the doctor to proceed with a more aggressive treatment than when treating sedentary patients.

Athletes cannot always follow the recommended paradigm of plantar fasciitis treatment. This includes rest and limited activity, which is not feasible for athletes who are working at a high level. Additional strategies that are recommended for treatment may also be impossible for athletes, such as a decrease in the length of stride or a change of running pace. These may negatively affect performance.

Heel Spurs

Although many sufferers of plantar fasciitis also have bone spurs, these do not cause pain. Ten percent of the population has heel spurs, yet only 5% of people with bone spurs experience pain. Because spurs do not cause plantar fasciitis, it can be treated without removing the bone spur.


While anti-inflammatories can help in the treatment of plantar fasciitis, the overuse of them may have a greater risk than benefit. Corticosteroid injections can negatively affect athletes, as they present a risk of spontaneous rupture in the heel. Those who have a higher body mass index or who have multiple corticosteroid injections have a higher risk of a rupture. This must be considered when an athlete is weighing the risks of not being able to return to their activity in a short amount of time.

Alternative Treatment

Treatment needs to be more focused on alternate ways to manipulate the forces on an ankle, foot, and heel. Athletes must be encouraged to keep up their cardiovascular fitness while resting from strenuous activities that may elongate the healing process. If a soccer player is banned from playing soccer for a certain amount of time in order to heal, doing other cardiovascular activities that are not harmful is important. For example, swimming, stationary cycling, and upper body weight machines can be helpful to keep the body in shape.


There has also been a great success in using semi-rigid custom foot orthoses in shoes. Athletes should consider foot orthoses at the initial onset of pain, because they are likely to subject their feet to additional stress throughout their healing time. Sedentary patients, however, do not need to rush to get orthoses, because these inserts are oftentimes more difficult to add to everyday footwear. Athletes, however, can easily add these to their athletic footwear. The insertion of orthoses or inserts can reduce the impact that is put on the foot, as well as compensate for extra weight that is constantly pounding on these tissues. Shoes may also be modified to reduce pressure on the foot, such as deforming the nubs on cleats.

Adjustable orthoses are able to address the various demands that are required by various playing positions. This includes running direction, dominant leg, and symmetry issues. Low profile inserts can be fit comfortably, while allowing biomechanical corrections without negatively affecting performance in the constraints of a tight shoe.

Night Splint

A night splint can be worn to hold the mechanics of the foot in place while resting. A splint that is fitted to the foot and calf can hold the band of tissue in the foot and Achilles tendon in an elongated position while resting.

Also while at home, heel cord stretching is important to decrease the stress on the foot and expedite healing. The use of these night splints has been proven to help treat plantar fasciitis, due to its ability to place the heel cord on a sustained stretch that remains static during rest.

Additional Help

Additional exercises and stretches may be done to strengthen the muscles in the lower leg. This will, in turn, stabilize the ankle and the heel. Athletic taping may also be applied to add additional support to the affected area.

Athletes tend to go to physical therapy, due to their willingness to invest extra time to speed up recovery. Athletes are typically used to being in the rehabilitation training room for various healing exercises and often already have a relationship with a physical therapist.

While healing plantar fasciitis, it is important to always wear supportive footwear that is stable. Open-back shoes should be avoided, as well as sandals and flip flops. Any flat shoes with no foot support should be avoided.

Rehabilitation and Return to Normal Activity

The goal of rehabilitation is to decrease the level of initial pain and the body’s inflammatory response. If the biomechanical dysfunction can be identified, it is easier to pinpoint the spots of the foot and ankle that need to be rehabilitated. With improved strength and flexibility, these tissues are able to endure more pressure without becoming damaged.

With a full rehabilitation, athletes are able to return to their regular fitness regime and prevent further injury. With the reduction of pain and inflammation, one may be likely to take more care as to not re-injure this area.

Cold Therapy

Using ice massage during rehabilitation for up to 10 minutes several times per day at the site of the pain can reduce pain and swelling. One easy way to perform an ice massage is to freeze a bottle of water and roll it on the bottom of the foot and around the ankle to apply the cold sensation.

Returning to Play

Before returning to normal activity, be sure to follow the advice of a physical therapist of professional in sports medicine. If no pain has been experienced for at least a week, normal activity can be resumed. However, this should be done gradually. If after beginning normal activity, pain returns at any time, it is important to take a step back, as to not further in injury.

Be sure to stretch properly before returning to play. Each training session should begin and end with a period of stretching. Stretches should be held for thirty seconds each and repeated at least five times.

Plantar fasciitis in sports will become increasingly prominent in the news as it continues to affect superstar athletes who are often in the media. Pressure applied on sensitive points of muscles and tissues in the body without a proper rest time in between impacts is what ultimately causes athletes to be most affected by plantar fasciitis. Trainers should help athletes to adopt measures to prevent this injury at every level of athleticism.

While average, sedentary people can take a modest approach to the treatment of this condition, athletes presented with this condition have to be treated more aggressively, due to their immediate need to get back to their normal activity, as well as their long-term goals in their sporting career. Employing every angle of treatment for athletes, including proper ice, foot support, rest, and the use of light medication can make an expedited formula of treatment. It is important, however, to always be cautious when trying to heal plantar fasciitis, as there are risks involved with the over treatment of the disorder that can end up causing longer-term consequences.

It is important to remember that the cornerstone of treatment for plantar fasciitis lies in the biomechanics of the foot, heel, and surrounding joints. The best way to not overload these tissues is to get the advice from a medical professional who specializes in podiatry. These doctors can adequately assess the situation while addressing the pathomechanics of the overload of pressure that has been applied to the foot by athletes with plantar fasciitis. Keeping the area in place to heal when it is not in use and being gentle when having to put additional pressure on the heel or foot are vital in the recovery of plantar fasciitis.


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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