Increasing activity through walking or jogging is a goal for which many strive, but exercisers are often limited by pain in the bottoms of their feet or heels. The pain starts as an ache during or after activity, or shows itself as a single, sudden jolt. Also quite common is pain in the arch or heels after sitting for prolonged periods of time and getting up, as well as in the morning with the first few steps. These are all likely symptoms of plantar fasciitis, inflammation of the plantar fascia.
The plantar fascia is a strong, fibrous structure that attaches to the heel bone on the bottom of the foot and runs down to the ball of the foot, or metatarsal heads. Its job is to cover the muscles on the bottom of the foot and help form the arch of the foot. Pain in this area can be progressively debilitating and eventually lead to problems walking and standing.
The most common causes of plantar fasciitis are sudden increases in activity like starting a new running program; changes in the exercise surface like going from a treadmill to pavement; changes in footwear like high heels or sandals; and sometimes acute injuries such as a twisted foot. Many of the causes of plantar fasciitis have a flattening of the foot in common. This can result from muscle stiffness at the ankles, knees, hips or lower back. Twisting the upper leg inward causes the foot to compensate and flatten, placing increased strain on and overstretching the plantar fascia.
The good news is there are self-treatments that can be very effective if implemented early. Stretching the calves and improving arch support in your footwear is the first step to recovery. If needed, icing, done by rubbing an ice cube on the painful area until the cube melts, can help with pain and initial inflammation. Self-massage can be done by, from a seated position, rolling the foot over a golf ball placed on carpet. If, during squatting, your knees turn inward or the feet turn out, the problem is likely coming from the hips or knees. In this case, practice squatting with the knees pointed straight ahead and without the knees going past the ends of the feet.
If icing, improved arch support and self-massage are not effective, the case might warrant an evaluation by your healthcare provider. A physical therapy assessment should include a comprehensive evaluation of gait, flexibility and your activities. Treatment may include augmented soft tissue mobilization, an ultrasound, stretching or hip muscle strengthening. In the worst cases, injections of cortisone may be needed at the site of pain to decrease the symptoms. Again, treating the pain and cause of the problem early will yield the best results.