Plantar Fasciitis and Plantar Fasciosis are extremely common foot injuries usually described as heel pain. The pain is usually felt first thing in the morning and after rest. Plantar Fasciitis is one of the most common injuries we see at FAANT. Plantar Fasciitis is seen in many athletes, and it is one of the most common running injuries. One study described PF as affecting 8% of habitual runners. 8%! When you calculate that approximately 2% of the US population runs on a regular basis (based on a survey of how many people ran a marathon in their lifetime). That is a lot of people. Actually the rough estimate is 6.2 million runners in the US alone with about a half a million suffering from heel pain. Wow! Oh my aching heel!
Why is there so much heel pain in runners? Too much, too soon, too fast syndrome. In other words, we want to be in shape way before our bodies are ready. The rule of adaptation states that our bodies become stronger with small, incremental increases in stress, but we break down with large incremental increases in stress. This is why Plantar Fasciitis is described as an overuse injury.
So how do we treat it? A protocol approach that follows a stepwise pattern that ends with 85% of runners having complete resolution with conservative therapy and 15% going on to move invasive surgical procedures.
Mainstays of treatment include:
- Better and/or different shoes
- Night splint
- Physical therapy
- Extracorporeal pulse activated treatment (EPAT)
Simply reducing pain and inflammation alone is unlikely to result in long term recovery, and rest is usually not enough. The minute the runners gets back to activity, their pain is back! I find that most runners, especially over the age of 40, desperately need to stretch their Achilles tendon and plantar fascia. The plantar fascia tightens up making the origin at the heel more susceptible to stress. The best way to do this is a combination of dynamic stretching throughout the day and a night splint. A plantar fascial night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.
So, why does a night splint work?
The plantar fascia is the ligament that holds up your arch. It is a thick band of fibers that go from the heel of the foot across the bottom of the foot to the toes. Plantar fasciitis is considered to be an inflammatory process following micro tears in the fascia. Plantar fasciosis is a degenerative process that occurs after several months of chronic plantar fasciitis. The reason PF causes so much pain in the morning, is that during the night the foot is relaxed and drops so the toes are pointed downwards. In this position the plantar fascia is relaxed, healing of the micro tears occurs overnight, but when the foot is put to the floor in the morning the fascia has to stretch to a longer position and this tears the new healing. Think of ripping a scab off every morning! Ouch! The idea of a night splint is that the foot is held overnight with the toes pulled upwards and thus the healing occurs with the fascia in its stretched position.
Many research studies have looked at night splints and the treatment of plantar fasciitis. There have been some mixed results due to the construct of the studies, but overwhelmingly the whole body of evidence suggests that night splints can help ease pain and assist healing, and this is especially true for people who have been suffering from plantar fasciitis for several months or more (truly plantar fasciosis).
Night splints do generally have to be used consistently for at least one month or more before significant improvement is seen. If you are a light sleeper, just make sure your wear it at least 4 hours a night.
A number of good night splints are available, and the fit and comfort is important given you will be wearing it for at least 6 weeks AFTER your symptoms resolve. A dorsal night splint will allow you to walk to the bathroom in the middle of the night without taking it off. A posterior night splint usually is better tolerated long term.
If you have an aching heel, request an appointment to get back on your feet!