Fascia, flexibility and fasciitis – some basic information regarding plantar fasciitis

heel-spur-plantar-info
Photo: aidmyplantar.com

by Janine Bryant for The Dance Journal

Almost one million Americans are affected by plantar faciitis (PF), which is the most common cause of chronic heel pain. {1} You could think of the plantar fascia as a strap that attaches the base of the toes to the heel base. {2} One can feel this strap tighten/lengthen upon dorsiflexion (toes up) and shorten upon plantar flexion (toes pointed).  Plantar fasciitis is an inflammation of this strap, or, plantar fascia, which is thick connective tissue, superficial to the intrinsic (deep) muscles of the foot.  The site of pain is frequently located at the medial calcaneal border (inside of the heel of the foot), where the fascia originates. {3} Inflammation is usually the body’s attempt at healing.  In this case, small avulsions (microscopic tears) occur from overuse such as in excessive jumping in dance or forcing turnout from the knees, which results in incorrect weight placement and pronation.

For dancers, if you have a really high arch or really low arch, or if you are not stretching enough, you can develop PF, tears and pain in the bottom of your foot from the inflammation. {2}

Clinical Presentation/Diagnosis:  Patients with PF will complain of plantar heel pain, exacerbated with the first step after a period of non-weightbearing, typically in the morning. {1} Diagnosis can be made by firm palpation at the medial (inside) aspect of the heel, just where the arch starts and the pain is pronounced if palpation is done with the toes forced back into dorsiflexion to tighten the PF, and lessened if palpation is done with the toes in neutral or slight plantarflexion, which relaxes the PF. {3} Imaging can also be done and may rule out other causes of plantar heel pain. {1}

Dancers should see their physicians if pain is persistent because the pain, although likely a result of PF, could also be a stress fracture of the heel.  In addition, dancers who persist in dancing through PF could develop a heel spur, which is a tiny spike of bone which has pulled out from where the plantar fascia inserts into the heel. {2}

Treatment:  Exercises to strengthen the arch and stretch the calf muscles are effective as well as stretching the Achilles tendon, which is an extension of the plantar fascia – foot flexibility is increased by paying attention to the flexibility of the entire lower leg and calf. {2} Physical therapy modalities, such as ice, ultrasound, electrical stimulation, and deep friction massage, can be useful in reducing the inflammation, while cortisone injections should be avoided, if possible, as they are excruciatingly painful and can cause atrophy of the heel fat pad, and have been associated with PF ruptures. {3} Patients with severe pain when arising from bed can achieve benefits from the use of a night splint or boot, which can provide a stretch lasting for many hours, while surgical treatment is a last line to be considered only after 6-12 months of conservative therapy. {1}

Inadequate treatment could result in a recurrence of the injury.  Therefore, dancers who experience this pain should seek help early on.  Stretch, stretch, stretch!  Pull your toes up throughout the day and stretch your Achilles tendon and calf muscles.

Until next time, friends, dance healthy and strong!

Janine Bryant
Co-Director of Dance
Eastern University
St. Davids, Pa.
Jbryant3@eastern.edu

  1. Martinelli, N, Bonifacini, C, Romeo, G, Current therapeutic approaches for plantar fasciitis, Orthopedic research and reviews, Dovepress, 2014.
  2. Peterson, Judith R., Dance medicine head to toe, a dancer’s guide to health, Princeton Book Co., 2011, pp. 129-132.
  3. Solomon, J, and R, Minton, SC, Preventing dance injuries, second edition, Human Kinetics, 2005, pp. 49-50.

 

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