Plantar Fasciitis

There's foot pain and then there's foot pain. Maybe you've felt it first thing in the morning, as you tentatively put one foot on the floor, fearful that putting weight on it will send a jolt of pain coursing through your body.

Walking down the stairs becomes unbearable, as you wince with every step. But the pain subsides as the day wears on. You can walk pain-free, maybe even exercise without any ill effects.

You could have plantar fasciitis.

It's a condition that has put an end to the dreams of countless people trying to get ready for their first marathon. It can also plague people who don't exercise but spend most of their day on their feet.

It kept Toronto Raptors basketball star Chris Bosh off his feet for three of his team's first six pre-season games. It could make the 2006-07 NBA season a winter of discontent for the talented player, unless team doctors give his sore heel time to heal.

What is plantar fasciitis?

Basically, it's an inflammation of the plantar fascia ligament — a fibrous band of tissue on the bottom of the foot that helps to support the arch. The ligament runs from your heel bone to the metatarsal bones of your toes.

The ligament may look like rubber bands, but it is made of collagen, a rigid protein that's not very stretchy. If it gets inflamed, you'll know about it pretty quickly.

What are the symptoms of plantar fasciitis?

You may experience a sudden pain in the foot, usually in the heel, where the plantar fascia ligament starts its journey to your toes.

The pain is usually most intense in the morning or after extended periods of inactivity. When not warmed up, the strained ligament contracts and sends you a reminder that it is inflamed when you put weight on it again.

When symptoms develop gradually, a more long-lasting form of heel pain may cause you to shorten your stride while running or walking. You may also try to compensate for the pain by shifting your weight closer to the front of your foot, away from your heel.

What causes plantar fasciitis?

You can develop plantar fasciitis if you overload or overstretch the plantar fascia. There are several ways you can do that, including:

• Increasing your exercise activity too much, too quickly — like adding too many kilometres to your running or walking program.
• Being on your feet for most of the day.
• Wearing worn-out shoes.
• Overpronation — your foot rolls inward excessively when you walk or run.

Is this a common injury?

Inflammations of the fascia probably account for up to 10 per cent of all athletic injuries, especially among runners and joggers who put tremendous stress on their feet — and most particularly among those who have high arches or flat feet.

Basketball and tennis players, people who do aerobics and dancers are all at risk. So are people who take up exercise after being sedentary for a long time and people who are required to be on their feet all day at work.

Plantar fasciitis is also common in obese people and pregnant women, as the extra weight they carry puts an increased load on the ligament. It is also more common in people with diabetes, although it's not clear why.

How is it treated?

The good thing about plantar fasciitis is that it usually responds well to treatment, if started fairly soon after the pain begins. It usually takes six to eight weeks to get over it — even though you will feel for most of that time that you may never get over it.

If you don't get treatment, the condition could worsen and you could be looking at a year or more of that morning pain and not being able to take part in some of your favourite activities.

Treatment programs could include:

• Stretching exercises to lengthen the heel cord and plantar fascia.
• Ice massage to the bottom of the foot after activities that trigger heel pain.
• A temporary switch to swimming and/or bicycling instead of sports that involve running and jumping.
• Shoes with soft heels and insoles.
• Taping the bottom of the injured foot.
• Physiotherapy using electrical stimulation.
• Acupuncture.

In addition, you may be required to wear a night splint for six to eight weeks. The splint keeps your foot in a neutral or slightly flexed position while you sleep. It helps maintain the normal stretch of the plantar fascia and heel cord.

There are several stretches you can do, including rolling a golf ball or a frozen bottle of water under your foot to help relieve the pain.

You may be prescribed orthotics to provide more support for your feet.

Cortisone shots are another option — but they can be very painful and only help about 50 per cent of cases. In rare cases, you may require surgery.

What's the prognosis?

Excellent, usually. At least 90 per cent of patients respond to six to eight weeks of conservative therapy, followed by six to eight weeks (if necessary) of night splints.

Still, it may be several months before the pain is totally gone.

How can I avoid plantar fasciitis?

Short of staying off your feet entirely, there are some steps you can take to lessen your changes of developing plantar fasciitis:

• Don't suddenly increase your exercise load. Do it gradually.
• Always wear shoes that will support your arch when you exercise.
• Maintain good flexibility around the ankle.
• What you wear on your feet when you're not exercising is important: your shoes should provide good support for your arches.
• Don't walk around barefoot or in flimsy shoes: both can delay recovery.