What is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the plantar fascia, a connective tissue that runs between the heel and the base of the toes, resulting from chronic wear and tear. “Supporting the arch, the plantar fascia…can become inflamed or torn,” according to the American Physical Therapy Association (APTA).
- Photo Courtesy of American Physical Therapy Association
What this shows is the plantar fascia as a broad sheet of tissue. While you can hear even some medical people refer to it as the plantar fascia tendon or the plantar fascia ligament, it’s not clearly either. A tendon connects bone to muscle. A ligament is bone to bone. Fascia can connect tissues and bones, but “it is unique because it is often broad and may enclose or envelop other structures,” according to Dr. Mark Vann, assistant professor of orthopedic surgery at the Baylor College of Medicine in Houston,Texas.
“There is definitely debate as to whether or not plantar fascia truly is a ‘fascia,’ but things only get more complicated from there,” he says. “The ‘tissue’ attaching to the heel bone (calcaneus) is a continuation of the plantar fascia and not separately described/identifiable as it too is made up of collagen. The other attachment at the base of the toes is also not separately definable, although some authors describe the plantar fascia as blending with the periosteum (the outer covering of the bones, which supply nerves and blood flow) as it ‘inserts’ at the base of the toes.”
“Not an easy anatomy answer, unfortunately,” according to Dr. Vann. “If I had to say which structure it most closely resembles (tendon vs. ligament), I’d have to say ligament.”
Whew. Anatomical arcana aside, the upshot is a condition that ranges from uncomfortable irritation to disabling pain.
Most people first experience plantar fasciitis in such a gradual way that it takes a while to realize there is a serious problem. We may feel discomfort in the heel during the night, find that the heel hurts when we step out bed and put weight on it. During a long car trip, we may wonder why the heck our heel hurts and keep shifting it this way and that around the gas pedal. Any time you sit for a while and then put weight on the foot, you may experience heel pain. Or you may feel it when climbing stairs, or after intense activity, or during a long walk on flat surfaces you feel the oft-described sensation of having a golf ball in your shoe under your heel.
More like a pebble, for me, but it felt like the pebble was inside the heel, rolling beneath it. There was a painful feeling of a slight snap within the heel, like something had swollen and was being crunched to the side when I walked.
“For most people, it’s that pain when you first stand up, or you wake up in the morning and put the foot down,” says Dr. Vann. “The typical person starts to take a few steps and complains of excruciating pain, and after a few steps it starts to get better. It has to do with the contracture of the plantar fascia if you’ve been off your feet a long time.”
And we may wonder what we did to strain the heel, how we stepped so wrong that we injured it or what the heck it was that we stepped on to produce such a painful bruise.
This is the point where we go to an MD, a podiatrist or chiropractor and get the diagnosis of plantar fasciitis. And then we ask, “What do I need to do to cure it?”
And while we’re at it, to what extent can it really be cured? And while we’re at that, Whattya Mean, Cured?