The triathlon training blog of Phil Barnes

PSA: Plantar Fasciitis

Taken from Runner's and Triathlete's Web Digest - March 2, 2007.
Posted for the benefit of my wife. A sufferer.

18. Plantar Fasciitis:
I often get patients walking in my office with a complain of heel pain. There are multiple causes of heel pain one of them being plantar fasciitis (plant-er-fa-she-eye-tes).

What is plantar fasciitis?
The name plantar fasciitis is somewhat misleading. The suffix “itis” means inflammation. And the plantar fascia is a band of fibrous tissue that extends along the bottom of the foot from the heel to the toes. Therefore plantar fasciitis should mean inflammation of the plantar fascia. However, in recent years it has been found that there is usually no inflammation present. What has been found is degeneration in the plantar fascia (scar tissue).

What is scar tissue?
With overuse of the plantar fascia, tiny tears form in the tissue. In the healing process our body attempts to repair that fascia with scar tissue, much like that scar that forms on the skin when you have scrapped or banged your elbow. As you can imagine, scar tissue is not as strong and flexible as normal, healthy undamaged tissue. Over time we can have a build up of this fibrous scar tissue if too much stress is put on the plantar fascia. This can lead to pain and dysfunction because this replacement tissue lacks the strength and flexibility of healthy tissue.

What are the symptoms of plantar fasciitis?
The classic symptoms of plantar fasciitis is pain under the heel that is worse in the morning or prolonged period of rest. The first few steps are really painful and that pain decreases with walking. When more advance there is also pain during normal activities.

How is plantar fasciitis treated?
Rest, ice and anti-inflammatory have traditionally been advised for plantar fasciitis with limited results. Some people may have this pain for months and even for more then 2 years with improper treatment. Since there is usually no inflammation but a scar tissue build up it important to break down the scar tissue. One soft tissue treatment technique that I use in my office is Graston technique. Patients usually notice an improvement of there symptoms on the first treatment. For more information on Graston technique visit my website at www.drstevepelletier.ca Other deep soft tissue technique can also work well to treat this condition. Orthotics might also be beneficial in some people to help support and relieve pressure on the plantar fascia. Extracorporal shock wave therapy can also be beneficial in patient in which other conservative therapies have failed.

Dr. Steve Pelletier, Centrum Chiropractic Clinic, (613) 830-4080, mailto:steve@drstevepelletier.ca