Plantar fasciitis is the most common cause of heel pain. It can be caused by inadequate or inappropriate footwear, weight gain, or a particular exercise or activity. It is common for plantar
fasciitis symptoms to affect only one foot at a time. Treatment focuses on reducing pain and inflammation. Chronic (long-term) plantar fasciitis can lead to a build-up of bone (a "spur") at the point
where the plantar fascia connects to the heel bone. For this reason plantar fasciitis is sometimes referred to as "heel spur syndrome".
Plantar Fasciitis is simply caused by overstretching of the plantar fascia ligament under the foot. So why is the ligament being overstretched? There are different factors, over-use, too much sports,
running, walking or standing for long periods (e.g. because of your job) weight gain, our feet are designed to carry a 'normal' weight. Any excess weight places great pressure on the bones, nerves,
muscles and ligaments in the feet, which sooner or later will have consequences. Even pregnancy (in the last 10 weeks) can cause foot problems! age, as we get older ligaments become tighter &
shorter and msucles become weaker; the ideal circumstances for foot problems, unsupportive footwear, 'floppy' shoes with no support as well as thongs affect our walking pattern, walking barefoot,
especially on hard surfaces like concrete or tiles, low arch and flat feet or over-pronation. An important contributing factor to Plantar Fasciitis is 'excess pronation' (or over-pronation). This is
a condition whereby the feet roll over, the arches collapse and the foot elongates. This unnatural elongation puts excess strain on the ligaments, muscles and nerves in the foot. When the foot is not
properly aligned, the bones unlock and cause the foot to roll inward. With every step taken your foot pronates and elongates, stretching the plantar fascia and causing inflammation and pain at the
attachment of the plantar fascia into the heel bone. Re-alignment of the foot should therefore an important part of the treament regime.
If you have Plantar Fasciitis, you will most likely feel a sharp pain under the ball of you heel and it will often give pain when standing after a period of rest. For example when you get out of bed
in the mornings or after being sat down. Some patients describe this feeling as a stone bruise sensation, or a pebble in the shoe and at times the pain can be excruciating. Patients with Plantar
Fasciitis can experience pain free periods whereby the think they are on the mend, only for the heel pain to come back aggressively when they appear to have done nothing wrong. If your plantar
fasciitis came on very suddenly and the pain is relentless, then you may have Plantar Fascial Tears. We will be able to differentiate between these 2 conditions, sometimes with ultra sound imaging.
The treatment for each of these conditions will need to be very different.
Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. Fascial pain along the plantar medial border of the fascia may also be
present. If findings are equivocal, demonstration of a heel spur on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs are not generally the cause of
symptoms. Also, infrequently, calcaneal spurs appear ill defined on x-ray, exhibiting fluffy new bone formation, suggesting spondyloarthropathy (eg, ankylosing spondylitis, reactive arthritis. If an
acute fascial tear is suspected, MRI is done.
Non Surgical Treatment
Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the
affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more
aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle,
eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in
some cases severely limiting athletic ability. As a large amount of time is spent in bed during sleeping hours, it is important to ensure that the sheets at the foot of the bed do not constrict the
foot, leading to plantar flexion in which the foot is bent straight out with the toes pointing. This constricts and thereby shortens the gastroc complex, worsening the condition. A heating pad placed
under the muscles of the calf for a few minutes prior to rising may help loosen tension, increase circulation in the lower leg and reduce pain. Also during sleep, a night splint may be used in order
to hold the ankle joint in a neutral position. This will aid in the healing of the plantar fascia and ensure that the foot will not become flexed during the night.
Surgery is not a common treatment for this condition. Approximately 5% of people with plantar fasciitis require surgery if non-surgical methods do not help to relieve pain within a year. The surgical
procedure involves making an incision in the plantar fascia in order to decrease the tension of the ligament. Potential risks of this surgical procedure include irritation of the nerves around the
heel, continued plantar fasciitis, heel or foot pain, infection, flattening of the arch, problems relating to the anesthetic.
Stretching the plantar fascia and the calf muscle area can help to prevent inflammation. Slowly increasing the amount or intensity of athletic activities by graded progression can also help to
prevent injury. Recommended Stretches: Taking a lunge position with the injured foot behind and keeping your heels flat on the floor, lean into a wall and bend the knees. A stretch should be felt in
the sole and in the Achilles tendon area. Hold the stretch for 20-30 seconds. Also try this stretch with the back leg straight.