PLANTAR FASCIITIS – THE
SMART WAY TO TREAT
Orthopedic Surgeon Gary Pattee offers advice to help you avoid and recover from the pain and strain of plantar fasciitis
GARY A. PATTEE, M.D. is a Diplomate of the American Board of Orthopaedic Surgery, a Fellow of the American Academy of Orthopaedic Surgeons, and a motorcycle-racing enthusiast.
All pickleball players know the thrill of victory, but many also unfortunately know the agony of the feet, a frequent complaint among those on the pickleball court. A common source of that pain is plantar fasciitis (“fa-shee-ai-tuhs”). The plantar fascia is a fibrous band of tissue across the bottom of the foot, running from the heel bone to the base of the toes, that helps support the arch of the foot and absorb shock when walking or running.
Pushing off on the ball of the foot, as one does while playing pickleball, places stress on the plantar fascia as it stretches. And repetitive stress can damage the ligament: microscopic tears (microtraumas) occur, usually where the plantar fascia attaches to the heel bone (called the calcaneus). This causes inflammation, a natural response to trauma, and leads to pain on the bottom of the foot near the heel. You’re particularly prone if you engage in repetitive high-impact sports, stand for prolonged periods on hard surfaces, have tight calf muscles or a “high arch,” or are obese.
Although the pain can become aggravated by excessive court time, it can similarly worsen after a period of rest following strenuous activities. For example, it’s quite common to have heel pain with the first few steps in the morning, before the ligament has had a chance to stretch.
The good news is that the pain of plantar fasciitis usually responds to simple treatments. The first step (no pun intended) is fairly obvious: reduce or temporarily stop the activities that make the pain worse. Gentle calf and plantar fascia stretches performed several times a day can be very effective in relieving symptoms. As with many sports injuries, icing can help, too. Roll your foot over a frozen water bottle for 20 minutes, 3-4 times a day. You can also try non-steroidal anti-inflammatory medications, but remember that they’re for short-term relief, and not recommended for long-term use.
A shoe insert (orthotic) is another option. It supports the arch and reduces tension along the plantar fascia. You can go for the custom-made, higher-priced versions, or simply buy them off the shelf—both are effective. Similarly, a silicone heel pad worn in the shoe also cushions the heel and may reduce pain. Although they are somewhat difficult to sleep with, night splints can be used to stretch the plantar fascia.
Of course, if after you have taken these measures the pain persists, it’s likely time to see a physician. After an examination, X rays may be obtained to rule out other conditions, such as arthritis and stress fractures. While a “heel spur” may be seen on an X-ray, it’s probably not the cause of the condition, as many people without heel pain have spurs. One note: MRI scans are usually not helpful in this evaluation and are typically reserved for cases in which other causes of pain are suspected.
Your physician may also consider an injection of a corticosteroid into the plantar fascia. This is very effective in reducing inflammation, but you need to tread carefully, so to speak. Repeated injections may be associated with weakening of the ligament and possibly a complete rupture, which can result in loss of the arch of the foot and chronic pain.
In those rare cases in which the pain persists after all conservative treatment measures have been exhausted, surgery can be performed to release the plantar fascia from the calcaneus, reducing some of the tension in the ligament.
As with many things, prevention goes a long way. Adding gentle calf stretching to your daily exercise routine is a simple way to reduce the odds of being left with painful feet from days on the court.