Plantar Fasciitis (PF) is a common source of heel pain. PF pain is located at the front of the base of the heel and is more prevalent in the morning when first getting out of bed. The excruciating pain is described by patients as, "It feels like a sharp rock stabbing the bottom of my heel." This pain often radiates into the arch of the foot. Plantar fasciitis occurs more commonly in: less experienced runners, uphill runners, those who walk on an inclined treadmill and exercisers who walk or jog on hard surfaces. Correcting intrinsic and extrinsic sources of plantar fasciitis will alleviate morning foot pain.
Anatomy
The plantar fascia is a thick sheet of tissue that connects the front of the heel to the front of the foot. It functions to support the long arch of the foot and to control pronation of the foot. Pronation is the inward rolling of the foot. According to the University of Michigan Health Systems, "If your foot flattens more than is normal, it is called over-pronation. Over-pronation can cause many problems, such as heel pain."
Periostitis
Plantar fasciitis is classified as periostitis. The periosteum is the outside lining of bone, thus periostitis in inflammation of this lining. Picture the periosteum as a Velcro covering, when the fascia exerts an increased amount of pull it lifts the periosteum away from the bone. While resting, your body attempts to reattach the outer lining to the bone. When your first steps are taken in the morning the periosteum is pulled away from the bone resulting in sharp, stabbing pain in the bottom of the foot.
Calf Muscle Tightness
Increased tonicity of the muscles in the calf and the Achilles tendon pulls the heel bone, or calcaneous, backwards. This prevents proper motion of the heel bone, and stretches the plantar fascia, thus increasing its tension on the periosteum of the heel bone. Visualize a tug of war between your Achilles tendon and your plantar fascia with your heel as the rope and the Achilles tendon having the advantage.
Contributing Factors
Intrinsic factors that contribute to plantar fasciitis and morning foot pain include: Tightness in the calf muscles and Achilles tendon, lack of forward motion of the calcaneous, weakness in the muscles that maintain the foot arches, and overpronation of the foot. Extrinsic factors include: sudden increase in running mileage, frequency and incline, and wearing shoes without proper arch support.
Self Treatment
Stretch and massage your calf muscles and Achilles tendon, strengthen the muscles of your foot's longitudinal arch, increase jogging volume in small increments and wear sneakers with adequate arch support to lessen the incorrect body mechanics that lead to foot pain. To alleviate plantar fasciitis pain apply ice after running, avoid walking without a heel strike, massage your calf before rising from bed and wear a night splint to lessen muscle tonicity. You may want to substitute biking or swimming for jogging until your foot biomechanics improve and your morning foot pain subsides.
References
- University of Michigan Health System: Over-Pronation
- "The Hiker's Engine"; Plotkin; 2002
- "Fixing Your Feet"; Copeland; 2005
- University of Maryland: Achilles Tendon
