Almost 100% of the time, plantar fasciitis (fash-eye-tis) is caused by a tightness in the calf muscle known as the gastrocnemius, or gastroc for short. The gastroc crosses the ankle through the plantar fascia. Plantar fasciitis is simply inflammation of the plantar fascia, a dense, fibrous structure along the sole of the foot and just beneath the skin that starts on the bottom of the heel bone (or calcaneus) and extends toward the ball of the foot. The plantar fascia acts as a tension band that helps to maintain the arch of the foot when your weight is on it.
The pain of plantar fasciitis tends to be at its worst with the first step out of bed in the morning and also following high-impact activities. Typically this pain will subside somewhat after that first step, and then may be more painful again by the end of the day.
Symptoms of plantar fasciitis can be severe enough to interfere with everything from basic daily activities to intense athletic training. In athletes, heel pain will most often increase during phases of higher-intensity and higher-volume training.
Some common risk factors for heel pain are overuse, pregnancy and obesity. Patients with a body mass index (BMI) greater than 30 are 5.6 times more likely to have plantar fasciitis than patients with a BMI less than 25. Overweight women are six times more likely to have plantar fasciitis than overweight men. Of course, weight loss is extremely difficult without exercise, and exercise is even harder with heel pain from plantar fasciitis.
If you have heel pain:
• Stretch regularly—especially the calf muscles.
• Replace your running shoes regularly.
• Seek medical treatment if necessary.
What can I do if I have plantar fasciitis?
There are a number of recommendations for non-operative treatment of plantar fasciitis. Night splints, physical therapy to stretch the calf muscles and foot, over-the-counter antiinflammatory medications and massage can also provide some relief. Modifications to footwear can also help alleviate plantar fasciitis. Cushioned running shoes are best for support and absorbing shock. Many running shoe specialty stores have an experienced fitter to make sure you get the best shoe fit and type for your foot. It's important to remember that the shock absorption of running shoes decreases dramatically after about six months or 500 miles, so be sure to replace your running shoes in accordance with these guidelines. Custom or prefabricated shoe inserts, called foot orthotics, have also been used to treat plantar fasciitis. However, recent studies have shown limited benefits of orthotics used specifically for plantar fasciitis.
More aggressive treatments of plantar fasciitis include cortisone injections and extracorporeal shockwave therapy, like that used to break up kidney stones. The results of these treatments have been mixed. Traditionally, surgical treatment has focused on heel spur surgery or plantar fascia release, which involves cutting a portion of the plantar fascia to relieve pressure and inflammation. Some providers have reported success with these treatments, but plantar fascia release has been implicated in painful arches, increased and new foot pain and even continued heel pain.
Surgical lengthening of the gastroc muscle has been effective in treating resistant, chronic plantar fasciitis, and in improving and maintaining ankle flexibility. In fact, a recent study has shown that 93.6% of patients experienced good or excellent results, which were relief of pain and return to sports, including running.* This procedure is called the "gastroc slide" because the gastroc muscle slides apart as it is lengthened. The gastroc slide is performed as an outpatient procedure through a small incision. The procedure can be performed in about 10 minutes. Following surgery, patients are allowed to walk with full weight-bearing in a walking boot. The boot is worn during sleep for one month following surgery. The boot can be removed for walking as soon as the patient feels comfortable doing so. Most patients are able to walk in a regular shoe three to seven days after the procedure.
Greater than 80% of heel pain gets better with non-operative treatment. The gastroc slide procedure, however, has been successful where other treatments have failed.
* “The Gastroc Slide for Chronic Plantar Fasciitis,” presented to American Orthopaedic Foot and Ankle Society by M. Chilvers, J. Rocco and A. Manoli in July 2007. Read the entire presentation online at www.utahorthopaedics.com.
