Pain in the foot is especially annoying. Pain in the bottom of the foot and heel will drive people crazy. There are over 3 million cases a year where people present and complain of pain in the bottom of their foot or heel. But what is it? Why does it happen? What can we do about it?

Plantar fasciitis is an all too common issue in our society today, with a report 3+ million cases presenting a year. But are they all truly plantar fasciitis or could it possibly be something else? This is an important lesson, as misdiagnosing such pain can affect our outcome as the different causes have distinctly different treatment/rehab protocols which we must follow. For this article, we will be discussing 2 different conditions with similar presenting patterns, those being plantar fasciitis and posterior tibial tendonitis.

To differentiate the two, we will first look at the presenting symptoms. There is one key symptom that is present with both plantar fasciitis and posterior tibial tendonitis, that being pain worse in the morning upon waking. These conditions have one main component that is similar, so how can we differentiate them? With plantar fasciitis, we see that pain is worse in the morning, but as we walk and move on the affected foot the pain decreases. This is due to the plantar fascia stretching and loosening up. On the other hand, posterior tibial tendonitis will proceed to get worse throughout the day as we walk and work on the affected foot. It is important to understand these differences as each diagnosis requires two separate treatment protocols.

But what if the pain is in both feet? Won’t we just do the everything the same as if it was only one foot? Once again this is where the differentiation of symptoms comes into play. When both feet are involved, we, must move away from looking and focusing on the feet and begin to look elsewhere, often looking to the pelvis. Both feet being involved with the same pain is an indication that feet may in fact be fine, but the structures that control the feet while we walk, and move may be the cause of the issue.

So how do we treat a true case of plantar fasciitis? Our first treatment protocol when dealing with plantar fasciitis, is to begin strengthening the intrinsic muscles of the foot, those muscles which are located within the foot itself. We accomplish this by utilizing exercises such as the short foot, toe grab, and banded resistance exercises for the big toe, just to name a few. As we build strength in our intrinsic foot muscles, we must begin to look at one the main culprits for foot weakness, our shoes. With our newfound foot strength, we will want to look to use a functional/barefoot style shoe. As we progress away from the tight, heeled, and cushioned shoes into a barefoot style shoe, we force or feet to work and continue building strength. This allows our feet to support the arch of the foot and the plantar fascia without the aid of added arch support. These options offer a great starting point to begin overcoming any case of plantar fasciitis that you may encounter, but remember that just because it feels like plantar fasciitis, doesn’t mean that it is.