Plantar fasciitis is a common cause of heel pain in adults. The pain is usually caused by collagen degeneration (which is sometimes misnamed âchronic inflammationâ) at the origin of the plantar
fascia at the medial tubercle of the calcaneus. This degeneration is similar to the chronic necrosis of tendonosis, which features loss of collagen continuity, increases in ground substance (matrix
of connective tissue) and vascularity, and the presence of fibro-blasts rather than the inflammatory cells usually seen with the acute inflammation of tendonitis. The cause of the degeneration is
repetitive microtears of the plantar fascia that overcome the body's ability to repair itself.
Plantar Fasciitis often leads to heel pain, heel spurs, and/or arch pain. The excessive stretching of the plantar fascia that leads to the inflammation and discomfort can be caused by the following:
Over-pronation (flat feet) which results in the arch collapsing upon weight bearing A foot with an unusually high arch A sudden increase in physical activity Excessive weight on the foot, usually
attributed to obesity or pregnancy Improperly fitting footwear Over-pronation (flat feet) is the leading cause of plantar fasciitis. Over-pronation occurs in the walking process, when a person's arch
collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone. With Plantar Fasciitis, the bottom of your foot usually hurts near the inside of the foot where the
heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. As the day
progresses and the plantar fascia continues to be stretched, the pain often subsides.
Plantar fasciitis is usually found in one foot. While bilateral plantar fasciitis is not unheard of, this condition is more the result of a systemic arthritic condition that is extremely rare in an
athletic population. There is a greater incidence of plantar fasciitis in males than females (Ambrosius 1992). While no direct cause could be found it could be argued that males are generally heavier
which, when combined with the greater speeds, increased ground contact forces, and less flexibility, may explain the greater injury predisposition. The most notable characteristic of plantar
fasciitis is pain upon rising, particularly the first step out of bed. This morning pain can be located with pinpoint accuracy at the bony landmark on the anterior medial tubercle of the calcaneus.
The pain may be severe enough to prevent the athlete from walking barefooted in a normal heel-toe gait. Other less common presentations include referred pain to the subtalar joint, the forefoot, the
arch of the foot or the achilles tendon (Brantingham 1992). After several minutes of walking the pain usually subsides only to re turn with the vigorous activity of the day's training session. The
problem should be obvious to the coach as the athlete will exhibit altered gait and/ or an abnormal stride pattern, and may complain of foot pain during running/jumping activities. Consistent with
plantar fascia problems the athlete will have a shortened gastroc complex. This can be evidenced by poor dorsiflexion (lifting the forefoot off the ground) or inability to perform the "flying frog"
position. In the flying frog the athlete goes into a full squat position and maintains balance and full ground contact with the sole of the foot. Elevation of the heel signifies a tight gastroc
complex. This test can be done with the training shoes on.
A physical exam performed in the office along with the diagnostic studies as an x-ray. An MRI may also be required to rule out a stress fracture, or a tear of the plantar fascia. These are conditions
that do not normally respond to common plantar fasciitis treatment.
Non Surgical Treatment
The initial treatment of plantar fasciitis focuses on reducing pain and inflammation. Resting the affected foot is the most important aspect of this treatment. Other initial treatment may include,
aplying ice to the sole of the foot, Anti-inflammatory medications. Gentle stretching of the plantar fascia and Achilles tendon. Physiotherapy. Taping the foot and ankle to provide adequate support
and alignment, Wearing supportive footwear with shock-absorbing soles or inserts. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Brufen) and diclofenac (Voltaren) are often used to
treat plantar fasciitis. It is unclear whether NSAIDs assist in the healing process but they are useful for controlling pain during treatment. If the condition does not respond to initial treatment,
a corticosteroid therapy may be recommended. This involves the injection of corticosteroid medication such as hydrocortisone (Solu-Cortef) directly into the affected area in order to treat the
inflammation and thus relieve the pain. Night splints to prevent the plantar fascia tightening during sleep may also be recommended at this stage.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting
their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the
tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is
released by making a cut into your heel, endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the
plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open
surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to
choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with
all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the
advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve
making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your
heel. It is claimed that EST works in two ways. It is thought to, have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process.
However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE
states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective
than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
While it's typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning, and three times during the day. Achilles Tendon Stretch. Stand with your
affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot, and lean into a wall. Bend the front knee and keep the back knee straight, heel firmly
planted on the floor. Hold for a count of 10. Plantar Fascia Stretch. Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your
shin until you feel a stretch in your arch. Run your thumb along your foot--you should feel tension. Hold for a count of 10.