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Marsh column: Plantar fasciitis can be a painful condition

Do you wonder if you have plantar fasciitis?
When you get up in the morning does it hurt to walk? Maybe after sitting for a long time, do your feet hurt when you stand and walk? You might be dealing with Plantar Fasciitis.
Plantar Fasciitis is an inflammation of the plantar fascia. Plantar means bottom of foot; fascia is a type of connective tissue — it means inflammation.
A classic sign of plantar fasciitis is heel pain with the first few steps in the morning. The pain is usually in the front and bottom of the heel, but it actually could be over any portion of the plantar fascia.
Plantar fasciitis is a repetitive strain injury involving foot muscles, tendons (the part that connects muscle to bone), ligaments (connects bone to bone) and the bones they attach to.
It is typically characterized by muscle imbalances when one or more flexor muscle/tendons are short/tight and one or more opposing extensor muscles/tendons are weak. One side of the muscle is tight and the other side is weak. Example: a tight calf muscle, and a weak tibialis anterior muscle (the small muscle on the outside of your shin bone)
What happens is:
• Repetitive impact on your feet and legs over time causes your flexor muscles/tendons to become short and tight.
• Repetitive impact on short, tight muscles/ tendons causes micro tearing at the point where the tendons attach to your heel and toe bones.
• Repetitive micro tearing at the point of attachments causes progressive scarring of tissue, inflammation and pain.
• Over a period of time, heel spurs and arthritis may develop.
Personally, I have to stay on top with good shoes. When I wear them out, I start to get tenderness in my heels. Just because the shoe still looks good does not mean it still gives you the proper support.
If you just started an exercise program and go too hard too soon and you do not stretch properly, your chance of getting plantar fasciitis is a lot greater.
Some basic treatments you could try are:
• Stretch the calf muscles several times a day, especially in the morning and after prolonged sitting.
• Ice after activity. You can freeze a “ribbed” plastic bottle with about three fourths of water, lay the bottle on a towel and move your foot back and forth over it.
• Stretch the plantar fascia in the morning.
• Rest
• Loose weight if possible, especially in overweight women. Extra weight causes excess tension in the plantar fascia.
• Heel cups can be beneficial. When you get older, the fat you need goes away, and the fat you don’t want arrives. The fat in your heels that you need is no longer there.
• Arch support, especially if you have flat feet.
A specialty shoe store such as Ralph Baker can really help you to get in the correct shoes and/or inserts. When starting an exercise program, start slow (especially with your New Year’s resolutions). If you are already exercising and want to increase your time, do it with small increments. Too fast too hard will set you up for injuries and that does not just include plantar fasciitis. And as always, check with your doctor, especially when the problem does not go away.
Ester Marsh, ACSM Cpt

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