A foot injury such as plantar fasciitis generally occurs in one foot. Bilateral
plantar fasciitis is unusual and tends to be the result of a systemic arthritic
condition that is exceptionally rare among athletes. Males suffer from a somewhat
greater incidence of plantar fasciitis than females, perhaps as a result of greater
weight coupled with greater speed and ground impact, as well as less flexibility
in the foot.
Typically, the sufferer of plantar fasciitis experiences pain upon rising after
sleep, particularly the first step out of bed. Such pain is tightly localized at
the bony landmark on the anterior medial tubercle of the calcaneus. In some cases,
pain may prevent the athlete from walking in a normal heel-toe gait, causing an
irregular walk as means of compensation. Less common areas of pain include the forefoot,
Achilles tendon, or subtalar joint.
After a brief period of walking with this type of foot injury, the pain usually
subsides, but returns again either with vigorous activity or prolonged standing
or walking. On the field, an altered gait or abnormal stride pattern, along with
pain during running or jumping activities are tell-tale signs of plantar fasciitis
and should be given prompt attention. Further indications of the injury include
poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc
complex, (muscles of the calf). Crouching in a full squat position with the sole
of the foot flat on the ground can be used as a test, as pain will preclude it for
the athlete suffering from plantar fasciitis, causing an elevation of the heel due
to tension in the gastroc complex.
Treatment
Treatment of plantar fasciitis is sometimes a drawn out and frustrating process.
A program of rehabilitation should be undertaken with the help of someone qualified
and knowledgeable about the affliction. Typically, plantar fasciitis will require
at least six weeks and up to six months of conservative care to be fully remedied.
Should such efforts not provide relief to the athlete, more aggressive measures
including surgery may be considered.
The initial goals of physical therapy should be to increase the passive flexion
of the foot and improve flexibility in the foot and ankle, eventually leading to
a full return to normal function. Prolonged inactivity in vigorous sports is often
the price to be paid for thorough recovery. Half measures can lead to a chronic
condition, in some cases severely limiting athletic ability.
As a large amount of time is spent in bed during sleeping hours, it is important
to ensure that the sheets at the foot of the bed do not constrict the foot, leading
to plantar flexion in which the foot is bent straight out with the toes pointing.
This constricts and thereby shortens the gastroc complex, worsening the condition.
A heating pad placed under the muscles of the calf for a few minutes prior to rising
may help loosen tension, increase circulation in the lower leg and reduce pain.
Also during sleep, a night splint may be used in order to hold the ankle joint in
a neutral position. This will aid in the healing of the plantar fascia and ensure
that the foot will not become flexed during the night.
Careful attention to footwear is critical in avoiding foot injuries. Every effort
should be made to wear comfortable shoes with proper arch support, fostering proper
foot posture. Should arch supports prove insufficient, an orthotic shoe should be
considered. Fortunately, most cases of plantar fasciitis respond well to non-operative
treatment.
Recovery times however vary enormously from one athlete to another, depending on
age, overall health and physical condition as well as severity of injury. A broad
period between 6 weeks and 6 months is usually sufficient for proper healing. Additionally,
the mode of treatment must be flexible depending on the details of a particular
athlete's injury. Methods that prove successful in one patient, may not improve
the injury in another.