Plantar Fasciitis  is the most common cause of pain on the bottom of the heel and usually defined by pain during the first steps of the morning. Pain also occurs at the start of activity and goe away with use. It seems to returns after a long rest and then restarting activity.

Plantar Fasciitis is considered a chronic injury rather than an acute injury. It is common in runners performing repetitive plantar flexion and dorsiflexion of the toes. It is also common with sudden weight gain.

The plantar fascia provides support for the medial longitudinal arch of the foot. The plantar fascia is stretched and the arch flattens slightly to absorb the impact each time the heel impacts the ground. The fascia is not very flexible and such repetitive stretching from impact can result in small tears in the fascia.

Symptoms

Heel pain during the first steps of the morning is a classic sign of plantar fasciitis. This pain is the result of the foot resting in plantar flexion overnight. This allows the fascia to shorten. When the shortened fascia is stretched pain occurs. Pain is also common at the start of exercise and when resuming activity after rest. A history of recent weight gain or a sudden change in exercise pattern also is a sign of plantar fasciitis.

Pain continues due to the chronic inflammation of the torn fascia. A heel spur can be a sign of fasciitis, but is typically not a cause. About half of patients with plantar fasciitis have spurs.

Typical causes of Plantar Fasciitis include overstretching a tight plantar fascial band or general overuse causing microtears to the fascia at its calcaneal origin.

Predisposing factors include:

    * Flat feet
    * High arches
    * Excessive pronation
    * Obesity or sudden weight gain
    * Tight achilles tendons
    * Sudden increase in activity intensity, time or type
    * Wearing shoes with poor cushioning
    * Change in running or walking surface
    * Occupation with prolonged standing / weight bearing

Treatment

Nonsteroidal anti-inflammatory drugs can be used for 2-4 weeks in conjunction with other treatments. (Check with your doctor for specific instructions).

It is important for those with plantar faciitis to avoid irritating activities, and barefoot walking on hard surfaces. Other treatments include weight loss when appropriate, heel cord (achilles) and plantar fascia stretching. Taping the heel and arch may also help reduce pain. Medial longitudinal arch supports, can be used if they produce a positive result.

Massaging the fascia by rolling foot over a 3-4 inch diameter tube such as a rolling pin or soup can has be an effective treatment.

A new stretching technique has proven effective at reducing the pain of plantar faciitis when performed several times a day. It is performed by crossing one leg over the other and pulling the toes toward the shin for a count of ten and repeating ten times. This is a change from the standard treatment that recommends the weight-bearing stretches.

Strengthening exercises include scrunching up a hand towel with the toes or pulling a towel weighted with a soup can across the floor. After exercising, applying a cold pack to heel at point of maximal tenderness for 15-20 minutes can relieve pain.

Proper footwear with arch support is also recommended.

Any foot injury that does not respond to treatment in 1-2 weeks may be more serious. Always consult a physician for a thorough evaluation and diagnosis.