By: Dr. Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN
Professional Rehabilitation Services

Summer is officially here. And with that comes the return of the heat, longer days, cook-outs, and that most treasured shoe in the south the easy-breezy shoe – the flip-flop. No longer worn only at the pool or beach, flip-flops have joined the list of our everyday footwear. But while seemingly comfortable, your flip-flops may in fact be putting you at risk for a foot disorder called plantar fasciitis – the most common cause of heel pain.

What is the plantar fascia?
The plantar fascia is a thick band of fibrous tissue (fascia) on the bottom of the foot, which runs across the bottom of the foot and connects your heel bone to your toes. Under normal activities it also acts as a shock absorber and stabilizes your foot during walking and weight bearing activities. When standing up and putting weight down through your foot the plantar fascia stretches and absorbs the stress or energy of the body supporting the arch in the foot.

People with flat feet – called pes planus tend to have loose plantar fascia, which can result in unstable feet. Those with high arched feet – called pes cavus tend to have tight plantar fasciae, which can result in feet that are rigid and unable to absorb shock.

What is plantar fasciitis?
Although plantar fasciitis can be brought on by an acute injury, most often it is tied to an overuse injury. Mechanical overload and excessive strain repetitively impact the plantar fascia. Like all tissues, if the tension becomes too great or occurs too often, it can create small tears in the fascia. Repetitive tearing can cause the fascia to become chronically irritated or inflamed, resulting in plantar fasciitis.

Heel pain which can also be brought on by causes other than plantar fasciitis, including neurologic causes such as referred pain from an irritated sciatic nerve, soft tissue causes such as tendonitis of the tibialis posterior muscle, and skeletal causes such as a stress fracture of the heel bone.

What are the symptoms of plantar fasciitis?
The symptoms of plantar fasciitis include foot pain that usually develops gradually; it usually affects just one foot, although it can occur in both feet simultaneously. It usually is worst with the first few steps in the morning after waking, and can be triggered by long periods of standing. Another symptom of plantar fasciitis is decreased ankle dorsiflexion, or a decreased ability to lift the foot bringing your toes up towards your shin. This can be due to a tight achilles tendon which attaches to the heel bone. A tight achilles tendon pulls the foot downwards towards the floor making it tough to lift the foot the opposite way. This can cause excessive stress to the plantar fascia, resulting in chronic injury and inflammation.

What are the risk factors for plantar fasciitis?
Several factors can predispose you to plantar fasciitis, including the following:

• Shoes that are thin soled, improperly fitted and lack well-supported arches and midsoles, which do not have the ability to absorb shock when on your feet.
• Walking barefoot
• Limited ankle dorsiflexion (flexing your foot so that your toes move towards your shin)
• Tight Achilles tendon
• Runners
• Obesity
• Pes planus foot type – flat feet
• Pes cavus foot type – high arched feet
• Abnormal walking pattern
• Weak plantar flexor muscles (the muscles that work to point your foot)
• Weak intrinsic muscles of the foot (the muscles within the foot that work to move the toes and support the arches)
• Occupations that involve prolonged standing

What’s wrong with wearing flip-flops?
Flip-flops, with their flat thin soles and unattached heel, offer no arch support and allow to much extra motion of the foot. Both of these conditions can easily overstress the plantar fascia, especially if your foot is already prone to the biomechanical abnormalities that come with pes planus or pes cavus foot types. And although wearing flip-flops has been found to be better than walking barefoot, a recent study determined that female flip-flop wearers experienced significantly more pressure at their heel bone and toe bases when walking than did females who wore athletic shoes. So if you’re planning on doing a lot of walking, consider leaving your flip-flops in the beach bag and instead choose a shoe that provides adequate arch and heel support.

How can I prevent plantar fasciitis?
Proper shoe choice, normal weight maintenance, and proper stretching and strengthening exercises may help to ward off plantar fasciitis.

How is plantar fasciitis diagnosed?
If you have foot symptoms that prohibit your favorite activities or are causing you to modify them, it’s a good idea to be examined by a physical therapist, podiatrist, and/or orthopaedic physician specializing in foot and ankle pain. Differentiating your symptoms starts with a thorough physical exam by a skilled clinician. Upon a diagnosis of plantar fasciitis your physician may recommend several different forms of treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to assist with pain and inflammation. Corticosteroids may be used through two different delivery processes, iontophoresis in which a corticosteroid solution is applied to the skin over the painful area and the medication is delivered with the aid of an electric current transdermally, or a corticosteroid may be injected directly into the plantar fascia by your physician. Night splints may be recommended to hold the plantar fascia and achilles tendon in a lengthened position overnight so that it can be stretched more effectively. Orthotics may also be recommended by your physician to help distribute pressure more equally in your feet with standing and walking activities.

Another form of treatment recommended by your physician may include a referral to physical therapy. Physical Therapists are skilled medical practitioners trained in biomechanics and human anatomy. At your initial consultation the Physical Therapist will perform a mechanical examination of your foot and ankle attempting to determine the exact cause of the irritant to the plantar fascia. Modalities such as ultrasound may be used to break up scar tissue, promote healing, and increase blood flow in the area. Soft tissue mobilization may be used to help reduce muscular tightness and tension in the plantar fascia. Iontophoresis may also be used as discussed to assist with decreasing swelling and inflammation. A Physical Therapist will also instruct you in a series of exercises and stretches to the plantar fascia and achilles tendon in order to improve ankle and foot alignment, mobility and to strengthen the lower leg muscles. A therapist may also use athletic taping techniques to temporarily support the bottom of your foot, limiting stress to the plantar fascia and allow healing. This reduction in inflammation and pain should allow you to more fully participate in your individualized treatment plan, thus leading you more quickly back to your favorite activities.

Professional Rehabilitation Services is a Physical Therapist owned Private Outpatient Physical Therapy Practice specializing in pain, orthopedics, balance and sports injuries with offices in Myrtle Beach and Pawleys Island, SC. For more information on this topic or to schedule a FREE 15 Minute Consultation please contact Brian Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, at our Pawleys Island office at (843) 235-0200, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN at our Myrtle Beach office at (843) 831-0163 or Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN at our Myrtle Beach office at (843) 839-1300, or visit us at: www.prsrehabservices.com