What Is Plantar Fasciitis

Plantar Fascitis

Overview

Plantar Fasciitis is a painful foot condition that affects the Plantar Fascia tendon that runs along the bottom of the foot (as seen in the picture). This tendon runs along the arches of the foot. Sometimes this tendon can become sore from normal use or strenuous activity, but this is not to be confused with the pain associated with Plantar Fasciitis. Small tears in the plantar fascia tendon can cause foot discomfort and pain, if left untreated, can become unbearable (seen in picture below). These tears are made worse by over-use, strenuous activity, weight gain, improper foot wear and a variety of other factors. Although there is no one absolute cause for the condition, it remains clear that this condition, while painful, can be corrected with products such as footwear, night splints, insoles and a variety of other plantar fasaciitis products.


Causes

The most frequent cause is an abnormal motion of the foot called excessive pronation. Normally, while walking or during long distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation. For more details on pronation, please see the section on biomechanics and gait. Clinically not only those with low arches, but those with high arches can sometimes have plantar fasciitis. The mechanical structure of your feet and the manner in which the different segments of your feet are linked together and joined with your legs has a major impact on their function and on the development of mechanically caused problems. Merely having “flat feet” won’t take the spring out of your step, but having badly functioning feet with poor bone alignment will adversely affect the muscles, ligaments, and tendons and can create a variety of aches and pains. Excess pronation can cause the arch of your foot to stretch excessively with each step. It can also cause too much motion in segments of the foot that should be stable as you are walking or running. This “hypermobility” may cause other bones to shift and cause other mechanically induced problems.


Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worst with the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position.


Diagnosis

The health care provider will perform a physical exam. This may show tenderness on the bottom of your foot, flat feet or high arches, mild foot swelling or redness, stiffness or tightness of the arch in the bottom of your foot. X-rays may be taken to rule out other problems.


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.

Plantar Fasciitis


Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.


Prevention

Make sure you wear appropriate supportive shoes. Don’t over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight, obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol – RICED-rest, ice, compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis, Consult a medical professional (such as a Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.

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