Plantar fasciitis is a chronic inflammation of the plantar fascia, a ligament-like structure that runs from the bottom of the heel to the underside of the toes of the foot. The plantar fascia helps to support the foot against downward forces that typically occur during running and jumping sports.

Signs and Symptoms:
The athlete may develop pain beneath the heel for no apparent reason or after suffering a minor foot injury. The injury is usually caused by a sudden twist of the foot or a misstep. Once the painful heel develops, the condition rapidly worsens until the athlete experiences considerable discomfort throughout the bottom of the foot. The pain is usually more intense when the athlete gets out of bed in the morning while putting weight onto the foot.

Causes:
Plantar fasciitis accounts for about 10 percent of all running injuries. Chronic tugging on the plantar fascia where the tissue attaches to the heel bone (calcaneus) causes this condition. This is an overuse injury resulting from the additive effects of repetitive abnormal forces that lead to the destruction of cell tissue and trigger the inflammatory process. Prolonged pronation of the foot (turning the sole of the foot outward) along with worn-out shoes are major contributing factors. Foot slap associated with downhill running may also aggravate the symptoms.

Treatment:
Treatment can be as simple as placing additional cushioning in shoes to surgery and extensive rehabilitation. During the acute phase, the treatment goal is to control pain and to reduce inflammation. Rest, ice applications, and oral anti-inflammatory drugs are effective in decreasing the inflammation about the heel. Next, athletes should stretch the plantar fascia and the Achilles tendon.

Stretching the plantar fascia requires holding onto a countertop or table and squatting down slowly with the knees bent. The heels of both feet must be kept in contact with the floor while squatting. After 10 seconds, straighten up and relax. The stretch is felt as the heels start to raise off the ground. Repeat this exercise 15-20 times. Stretching the Achilles tendon requires leaning into a wall. Place one leg back behind the other leg. Keep the back knee straight with the heel on the ground while bending the front knee. While leaning forward, the stretch should be felt in the heel cord and foot of the straight leg. Again, after 10 seconds, straighten up and relax. Repeat this exercise 15-20 times with both legs.

The athlete may need to purchase arch supports and heel pads for their existing shoes to support the fascia. If the running shoes are worn, purchase new shoes that have a firm arch support and firm heel cup to buffer forces at impact. If symptoms persist for more than two months, a steroidal heel injection and custom-made foot orthoses to reduce pronation may be required. Ninety-five percent of the athletes are usually able to return to normal exercise within six to eight weeks.

If the symptoms become chronic, the athlete may require a night splint that keeps the plantar fascia and Achilles tendon in a stretched position. In rare cases, surgery is necessary to release the fascia at the heel and/or remove a bony spur that may have formed. This treatment phase requires extensive physical therapy and rehabilitation.

The ideal management of plantar fasciitis is prevention. Essentially, if the athlete performs appropriate warm-up exercises, wears quality shoes, and exercises at an appropriate training level on a safe surface, this condition can be prevented.