Your alarm goes off and you don't even need to hit snooze!  You hop right out of bed but as soon as your foot hits the floor you let out an "OWWWWW!"  There is a sharp pain on the bottom of your foot, right near your heel, that makes you jerk your foot up off the floor and want to crawl back into bed!  Finally, you work up the courage to put your foot back down and now, more gingerly, you hobble across the floor to start your day. What could possibly cause such a sharp pain?  What can you do to get rid of it?

First, let's start with what the plantar fascia is and how it can be injured.  The plantar fascia is a very thick, strong band of tissue that runs from your heel to your forefoot (just before your toes).  As you shift weight onto your foot, your ankle bones 'unlock' to increase your mobility, allowing you to adapt to the surface and absorb shock.  Your muscles and ligaments will control and limit most of that increased mobility, as will your plantar fascia. Think of your foot bones as forming a bow with the plantar fascia attached from end to end as the bowstring.  

The plantar fascia is not a muscle and it does not actively contract or relax.  When excessive force is place upon it, it will break down at its weakest link. This will frequently be where it attaches to the heel bone (calcaneus), particularly along the inside.  This will create inflammation and cause your body to respond by laying down calcium, attempting to heal the tissue back to the bone.  However, this only creates a bone (or heel) spur that can be painful in its own right.  Other times, the weak link may be somewhere along the plantar fascia, anywhere in the arch.  This strain may lead to a tearing that your body will respond to by creating scar tissue. 

In both cases, the initial treatment should be geared towards stretching the plantar fascia, eliminating inflammation and identifying the poor biomechanics that allowed the excessive strain in the first place.In many cases, the culprit is muscle weakness that does not adequately control the amount or speed of pronation (falling) of the arch.  This weakness could be present at the hip or the foot, as weakness in either spot can directly influence pronation.  Strengthening and neuromuscular control exercises usually correct this problem, however, sometimes you will need a foot orthotic to help support your arch and reduce the strain on the plantar fascia.

In some instances, a change in activity level or work conditions may result in the plantar fascia tightening enough so that even a mild weakness will cause a strain.  Other possible causes might include a change in running surface or training distance or time.  Consider your shoe wear...did you just switch shoe brands, get new shoes or need to purchase new shoes?  All these factors could be the 'straw that breaks the camel's back' and causes the strain that leads to heel pain.  Hopefully responding to initial discomfort and tightness with stretches can prevent your plantar fascia problem from progressing into a bone spur.  The proper steps (pun intended!) taken early on will prevent much pain in the long run!