Understanding Plantar Fasciitis

Plantar fascitiis is the most common cause of heel pain, affecting approximately 2 million individuals in the United States each year. Clinical manifestation and diagnosis is well recognized based on physical examination and symptoms. This condition occurs along the long plantar fascia ligament, which is a fibrous tissue that spreads across the bottom of the foot connecting from the calcaleus (heel bone) to the proximal phalanges (toes). This structure takes tremendous stress with each step we take. Repetitive activation or irritation of the fascia can lead to mechanical overload and micro tears.
Risk factors which may predispose one to development of fasciitis include decreased ankle flexibility, improper mechanics of the foot, wearing incorrect shoes, being overweight, repetitive activities such as athletes participating in running and jumping. Other causative factors may include standing workers, sustained repetitive stress, and calcaneal heel spurs.  
Typical presentation is heel pain that has been slowly progressive and most noticeable with the first step in the morning or after being sedentary for extended periods. Pain is often sharp or shooting with each step and a progressive dull ache throughout the day. If signs and symptoms are not clear, further diagnostic modalities or consulting with your health care provider may be warranted.
Conservative treatment is the mainstay for recovery. Recovery times may vary, however it is important to understand and adhere to a regimented treatment protocol to achieve success. Symptoms are often self limiting and resolve in 80-90% of people affected within 10 months. Initial treatment should consist of resting and icing. Icing can be performed by freezing a water bottle, soda can, or Dixie cup and rolling the heel over the cylindrical object. Exercises should include specific plantar fascia stretching multiple times per day (see below). Physical therapy has also become a common option to help guide this process and promote healing. Other treatment options for plantar fasciitis include massage, taping techniques, orthotics, and night splints. For more severe and chronic cases that are unresponsive to conventional treatment, casting, steroid injections, anti-inflammatories, and modalities may be utilized.  Surgery is the last option for those who have failed all other treatment approaches.
Here are some take home points. Do not ignore your foot pain. If your signs and symptoms are consistent with plantar fasciitis, you will likely benefit from conventional treatment which consists of icing the sore heel, stretching and massaging the plantar fascia, maintaining a healthy weight, and using proper shoe wear. Please consult your health care professional to determine proper dosage and appropriateness of suggested exercises.  
   Lindsey Welch is a licensed physical therapist at Strive Physical Therapy and Sports Rehabilitation in Moorestown, NJ. She treats a wide variety of musculoskeletal disorders ranging from orthopedics to generalized low back pain. She holds a Doctorate in Physical Therapy from Thomas Jefferson University and is a certified strength and conditioning specialist through the NSCA.

References:

http://www.plantar-fasciitis.org/. Accessed on December 13, 2009.
Mayo Foundation for Medical Education and Research. Accessed on December 13, 2009. http://zcoilblog.blogspot.com/2009/08/foot-stretches-to-prevent-plantar.html
Sanders, Mary E. On the Floor: Keep Trekking with Healthy Happy Feet: Understanding Plantar Fasciitis. ACSM’s Heath & Fitness Journal. 11(4): 29-32, July/August 2007.
Schippert, David W, DiGiovanni, Benedict F, et al. Recent updates in the management of plantar fascitis. Current Orthopaedic Practice. 20(2):130-135, April 2009.

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• Tip of the Month

  June 2010

  Abdominal Workouts: Frequency, Intensity, and Duration

  Over the past 15 years, there has been countless advice on how to “properly” train your abdominals, or core.  There isn’t a fitness magazine out there that doesn’t publish a different abdominal workout each and every issue.  Opinions and research may change over time, but there are a few things you should look at before you alter your workout with each Fitness Magazine you read!
  First of all, it is important to know what your overall fitness and health goal is before designing a strength program for any body part, especially the mid-section.  For overall fitness, it is smartest to treat your abdominal muscles as you would any other muscle group.  The tried and true guidelines for most exercise programs is to work specific muscles to fatigue within a 30-60 second set time limit (intensity and duration,) while giving the worked muscle group at least 24-48 hours of rest (frequency) before working it again.  The amount of sets you do in a given workout (frequency again) can vary from as little as 4 sets to up to 12 for the average workout.  The science behind these theories is sound.  While exercising, pushing your body significantly past the 60 second mark without fatigue generally incorporates aerobic energy, thereby not stressing the muscles most efficiently.  And rest is necessary so that your body can properly rebuild the muscle fibers that you have broken down.  Additionally, you want to be at 100% energy levels for your next workout!

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• Recipe of the Month

  June 2010

  Ham and Cheese Breakfast Casserole

  This healthy update of a traditionally rich ham-and-cheese breakfast strata is made lighter primarily by losing a few egg yolks and using nonfat milk. Gruyère cheese has a delicious, nutty aroma and flavor, which means that with the relatively small amount in this recipe you still get a big impact. To finish the makeover use nutritious, fiber-rich, whole-grain bread instead of white. The results: plenty of flavor, half the calories and one-third the fat of the original.

  4 large eggs
  4 large egg whites
  1 cup nonfat milk
  2 tablespoon Dijon mustard
  1 teaspoon minced fresh rosemary
  1/4 teaspoon freshly ground pepper
  5 cups chopped spinach, wilted (see Tip)
  4 cups whole-grain bread, crusts removed if desired, cut into 1-inch cubes (about 1/2 pound, 4-6 slices)
  1 cup diced ham steak, (5 ounces)
  1/2 cup chopped jarred roasted red peppers
  3/4 cup shredded Gruyère, or Swiss cheese
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