SYMPTOMS

• Pain experienced under the heel and/or along the arch of the foot. (Figure 4 and 5)
• Pain that is worse with the first steps in the morning and after prolonged sitting.
• Dull intermittent pain which can progress to sharp persistent pain.
• General stiffness felt in foot/ankle.
• Pain often described as, "a hot poker through the bottom of the foot".

DEFINITIONS
Plantar Fasciitis

• An inflammation of the connective tissue of the bottom of the foot.
• Plantar= bottom of the foot, Fascia=dense fibrous connective tissue, Itis=inflammation
• The plantar fascia attaches to the bottom of the heel bone and fans out to the toes.
• The plantar fascia is designed to support the foot and form the arch. It has very little elasticity and is very thick. Heel Spurs
• A heel spur is an abnormal growth of bone on the heel due to excessive stress or pulling where the plantar fascia attaches to the heel.
• The excessive tugging of the plantar fascia on the heel bone causes this excess of bone (bone spur) to grow in a pointed fashion.

PRIMARY CAUSE
Excessive Pronation

• Pronation is a normal movement of the foot that helps the body to absorb shock and adapt to different ground surfaces.
• In analyzing ones gait, first contact is on the heel and outside of the foot; followed by a shift of body weight continuing forward toward the arch and toes.
• If the foot is weak or tired and/or the footwear is not supportive, then the arch can flatten more than normal, which is excessive pronation.
• Flattening of the arch (excessive pronation) places pressure on the arch and stretches the plantar fascia (which supports the arch) and can create inflammation at the attachment on the heel.
• This repetitive, excessive pronation, is the main contributor to many lower extremity, overuse injuries, of which plantar fasciitis and heel spurs are the most common in the foot.

CONTRIBUTING FACTORS

• Age-With increasing age, often there is decreasing flexibility.
• Any sudden change in activity, specifically activities that increase weight bearing or pressure on the foot.
• Changes in training - Increased toe running, speed of running or hill running can add stress to the feet.
• Flat, pronated feet or rigid, high arched feet may be more prone to problems.
• Sudden increase in body weight (such as pregnancy) may also add strain.
• Poor support in the shoes being worn and/or the poor support inside the shoes can add to the stress on the foot.
• Biomechanical changes in the foot can cause increases in pronation (see Primary Causes).

TREATMENT - ADVICE GIVEN MOST OFTEN IN CURRENT LITERATURE

• The 3S's - Supporting, Stretching, and Strengthening, along with ICE and REST,have been found to be the simplest and most effective treatment for these injuries.
• Supporting the foot with proper shoes and insoles, can prevent or eliminate the vast majority of foot related problems.
• Stretching of the calf, Achilles tendon and foot can help or eliminate the majority of plantar fasciitis problems.
• Strengthening the muscles of the foot and ankle can assist in eliminating and avoiding these problems.
• Arch supports are recognized as the most successful remedy with stretching a close second.