What Is Plantar Fasciitis

Pain Of The Heel

Overview

Foot pain affects nearly all people at one time or another. It can also lead to other musculoskeletal problems such as ankle, knee and back pain (Hill et al., 2008). This pain negatively affects one’s quality of life and ability to enjoy workouts and/or maintain a regular program of exercise. One of the most common sources of foot pain is plantar fasciitis, a condition where the connective tissue on the underside of the foot becomes irritated and painful as a result of an injury, overuse or misuse. The plantar fascia is a system of connective tissue that runs from your heel to just behind your toes. During weightbearing activities, such as walking or running, your body weight is transferred onto your foot from your heel to your toes (which results in your toes moving away from your heel). This spreading out of the foot places tension on the plantar fascia because it connects those two parts. If the tension on this structure is too great or is not dispersed evenly, the plantar fascia can develop microtears and become irritated and painful, resulting in a condition called plantar fasciitis.


Causes

It usually starts following an increase in activity levels. Increase in weight. Standing for long periods. Poor footwear. Tight muscle groups. Abnormal pressure on the plantar Fascia can be caused by any of the above. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area that then causes the pain on standing.


Symptoms

The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense with the first steps of the day. Individuals with plantar fasciitis often have difficulty with dorsiflexion of the foot, an action in which the foot is brought toward the shin. This difficulty is usually due to tightness of the calf muscle or Achilles tendon, the latter of which is connected to the back of the plantar fascia. Most cases of plantar fasciitis resolve on their own with time and respond well to conservative methods of treatment.


Diagnosis

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

Talk to your doctor about the best treatment plan for you. Options include. Apply ice or a cold pack to the heel and arch for 15 to 20 minutes several times a day. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin. A special splint that will hold your foot in a neutral position while sleeping. Special shoe inserts that support the mid-arch region of your foot. Inserts that are not customized may work just as well as those that are customized. Activity. Avoid running and other activities that may worsen pain. Begin stretching exercises to lengthen the Achilles tendon and plantar fascia as recommended by your doctor. This is usually done when pain has lessened or improved. To help manage pain, your doctor may recommend over-the-counter nonsteroidal anti-inflammatory medication (NSAIDs), such as ibuprofen or naproxen. Prescription pain relievers may also be required. Steroid injections may be used in some cases or if other treatment is not working. A special type of sound wave called extracorporeal shock wave may also be considered in certain cases. This treatment happens under the care of your doctor. At this time, this is generally a treatment for long-term cases that do not respond to other treatments. Massage therapy or accupuncture may also be effective for long-term cases. In a few cases, basic treatments don’t help. Surgery may be performed to cut the tight, swollen fascia.

Foot Pain


Surgical Treatment

Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage.


Prevention

The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise or walk a lot or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Keep a healthy weight. Do your leg and foot stretching exercises regularly.

What Leads To Plantar Fasciitis And The Ways To Deal With It

Painful Heel

Overview

The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. Through overuse the fascia can become inflamed and painful at its attachment to the heel bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is thought to be degeneration of the collagen fibres close to the attachment to the heel bone.


Causes

The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot. Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers. Disruptions in the plantar fascia’s normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by placing excess strain on the calcaneal tuberosity.


Symptoms

Plantar fasciitis generally occurs in one foot. Bilateral plantar fasciitis is unusual and tends to be the result of a systemic arthritic condition that is exceptionally rare among athletes. Males suffer from a somewhat greater incidence of plantar fasciitis than females, perhaps as a result of greater weight coupled with greater speed and ground impact, as well as less flexibility in the foot. Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.


Diagnosis

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.


Non Surgical Treatment

If you protect your injured plantar fascia appropriately the injured tissues will heal. Inflammed structures will settle when protected from additional damage, which can help you avoid long-standing degenerative changes. Plantar fasciitis may take from several weeks (through to many months) to heal while we await Mother Nature to form and mature the new scar tissue, which takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that may become lumpy or potentially re-tear in the future. It is important to lengthen and orientate your healing scar tissue via massage, gentle stretches, and light active exercises. In most cases, your physiotherapist will identify stiff joints within your foot and ankle complex that they will need to loosen to help you avoid plantar fascia overstress.A sign that you may have a stiff ankle joint can be a limited range of ankle bend during a squat manoeuvre. Your physiotherapist will guide you.

Heel Pain


Surgical Treatment

The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including. Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.

What May Cause Heel Discomfort And The Ways To Get Rid Of It

Heel Pain

Overview

If your first step in the morning often feels like it involves a rusty nail being inserted into your heel, you’re not alone. Heel pain resulting from plantar fasciitis is the most prevalent condition treated in podiatric clinics, and an additional 1 million Americans annually are seen by medical doctors for the condition, according to the Centers for Disease Control and Prevention. The plantar fascia is the ligament that runs from the heel bone across the entire bottom of the foot and connects at the base of the toes. Ligaments connect bone to bone, and don’t really constrict or contract, but can become thickened because of inflammation. Inflammation of the plantar fascia can cause strain when you walk, specifically heel pain that is especially bad for the first few steps after prolonged inactivity. It then typically loosens up once you’re up and about.


Causes

It usually starts following an increase in activity levels. Increase in weight. Standing for long periods. Poor footwear. Tight muscle groups. Abnormal pressure on the plantar Fascia can be caused by any of the above. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area that then causes the pain on standing.


Symptoms

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.


Diagnosis

Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.


Non Surgical Treatment

At the first sign of soreness, massage (roll a golf ball under your foot) and apply ice (roll a frozen bottle of water under your foot). What you wear on your feet when you’re not running makes a difference. Arch support is key, and walking around barefoot or in flimsy shoes can delay recovery. If pain is present for more than three weeks, see a sports podiatrist. Treatments such as orthotics, foot taping, cortisone injections, night splints, and anti-inflammatories decrease symptoms significantly in about 95 percent of sufferers within six weeks. For more stubborn cases, physical therapy may be prescribed; six months of chronic pain may benefit from shock-wave therapy, an FDA-approved plantar-fasciitis treatment.

Foot Pain


Surgical Treatment

Surgery for plantar fasciitis can be very successful in the right patients. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery. New surgical techniques allow surgery to release the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia. This procedure is called an endoscopic plantar fascia release. Some surgeons are concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot. While there is no definitive answer that this endoscopic plantar fascia release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach.


Stretching Exercises

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.

What Causes Heel Discomfort To Appear

Heel Discomfort

Overview

Plantar fasciitis is a very common condition resulting in pain under the heel which often radiates into the foot. We explain free of charge everything you need to know to cure your pain and prevent it from returning.


Causes

It usually starts following an increase in activity levels. Increase in weight. Standing for long periods. Poor footwear. Tight muscle groups. Abnormal pressure on the plantar Fascia can be caused by any of the above. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area that then causes the pain on standing.


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

Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may also examine you while you are sitting, standing, and walking. It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause plantar fasciitis. An X-ray may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will remain.


Non Surgical Treatment

Anti-inflammatory agents used in the treatment of plantar fasciitis include ice, NSAIDs, iontophoresis and cortisone injections. Ice is applied in the treatment of plantar fasciitis by ice massage, ice bath or in an ice pack. For ice massage, the patient freezes water in a small paper or foam cup, then rubs the ice over the painful heel using a circular motion and moderate pressure for five to 10 minutes. To use an ice bath, a shallow pan is filled with water and ice, and the heel is allowed to soak for 10 to 15 minutes. Patients should use neoprene toe covers or keep the toes out of the ice water to prevent injuries associated with exposure to the cold. Crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because it can be molded to the foot and increase the contact area. A good alternative is the use of a bag of prepackaged frozen corn wrapped in a towel. Ice packs are usually used for 15 to 20 minutes. Icing is usually done after completing exercise, stretching, strengthening and after a day’s work.

Plantar Fascitis


Surgical Treatment

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).