PLANTAR FASCIITIS

Plantar fasciitis (Heel pain) is when your plantar fascia, the thick fibrous band of connective tissue from your heel bone to toe, develops micro tears or becomes inflamed. The plantar fascia acts as a passive limitation to the over flattening of your arch.

Especially common in running and impact sports that involve toe running rather than heel running styles. There are two possible methods for the cause of plantar fasciitis, either traction or compression injury.

  1. Traction Plantar Fasciitis
    • Usually exacerbated by traction forces (stretching) on the plantar fascia
    • Over stretching the plantar fascia repeatedly
    • Poor foot biomechanics (e.g. over pronation)
  2. Compression Plantar Fasciitis
    • Injury resulted from traumatic history
    • Most common from landing on a sharp object that bruises the planta fascia

Plantar Fasciitis is more likely to develop into individuals who are:

  • Active – sports that place excessive stress on the heel bone and attached tissues
  • Overweight – Carrying extra weight increases the strain and stress on your plantar fascia
  • Pregnant – Weight gain and swelling causes ligaments to become relaxed, leading to mechanical problems and inflammation
  • Flat feet – Changes in arch support changes the shock absorption ability causing additional stress and strain on the plantar fascia
  • Middle-Aged or Older – With age the arch of your foot begins to sag, putting extra stress on the plantar fascia

SYMPTOMS

Typically, the first symptom of early onset plantar fasciitis is pain under the heel or in the foot arch after rest. The pain will be worse in the beginning and improves as the area warms up from activation. Plantar Fasciitis symptom progression can be broken down into five stages:

  • No heel pain – Normal
  • Heel pain after exercise
  • Heel pain before and after exercise
  • Heel pain throughout exercise; before, during and after
  • Constant heel pain including when rested

The symptom progression is consistent with the stages of a typical overuse injury. Ultimately, further trauma and delayed healing will result in the formation of calcium within the plantar fascia, which will increase recovery period.

DIAGNOSIS

Plantar Fasciitis can usually be diagnosed by your history, symptoms and a simple clinical examination by a physiotherapist. In certain cases, an X-ray may show calcification within the plantar fascia, whilst ultrasounds and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.

TREATMENT

Plantar fasciitis is reversible and very successfully treated, roughly 90% success rate within two months of initial treatment. In extreme cases, a steroidal anti-inflammation medication may need to be injected into the heel. Although shown to have short-term benefits, progress in medium to long term is increased and recurrent bouts occur for longer.

As poor foot biomechanics is a primary factor in plantar fasciitis, correction to foot and leg biomechanics is required to prevent future episodes of plantar fasciitis. Additionally, there is essentially 6 stages that need to be covered to effectively rehabilitate plantar fasciitis

1) Early Injury Protection

  • As with most soft tissue injuries the initial treatment is Rest, Ice, and Protection.
  • Ice is simple and effective at reducing swelling and pain – apply for 20-30minutes every 2 hours
  • Anti-inflammatory medication may be used to reduce swelling
  • Pain reduction medication may be used in extreme cases
  • A brace or foot tape may provide pain relief

2) Regain Full Range of Motion

  • If protected, an injured plantar fascia tissue will heal
  • Healing may take several weeks for new scar tissue to form
  • Massage and gently stretch the scar tissue to promote a healthy formed tissue

3) Restore Foot Arch Muscle Control

  • The foot arch is dynamically controlled via important foot arch muscles, which may be weak or have poor endurance.
  • Poor foot muscles lead to instability at the base of your feet causing excessive loading to the plantar fascia
  • Corrective assessment is required to improve dynamic foot control and better your feet’s biomechanics

4) Restore Calf and Leg Muscle Control

  • Your leg plays an important role in controlling your foot arch and its normal function
  • A physiotherapist will assess your leg muscle’s function and provide necessary treatment or exercise

5) Improve Running and Landing Techniques

  • Corrective technique and exercises is required to address important components of rehabilitation

6) Footwear Analysis

  • Poorly designed footwear can cause plantar fasciitis
  • Orthotics may be required in certain cases to improve your foot’s biomechanics and stability
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