PLANTAR FASCIITIS

PLANTAR FASCIITIS

Plantar fasciitis, one of the common causes of pain in heel, is due to irritation and inflammation of plantar fascia (a long thin band that connects heel to front of toes, and supports the arch of the foot).

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fascia.

Risk factors for plantar fasciitis include:

•  Walking gait abnormalities, which place excessive stress on the heel bone, ligaments, and  nerves near the heel
•  Running or jogging, especially on hard surfaces
•   Poorly fitted or badly worn shoes, especially those lacking appropriate arch support
•   Excess weight and obesity

Other risk factors associated with plantar fasciitis include:

•  Increasing age, which decreases plantar fascia flexibility and thins the heel's protective fat pad
•  Diabetes
•  Spending most of the day on one's feet
•  Frequent short bursts of physical activity
•  Having flat feet or high arch feet.

Heel Spurs

Heel spurs are often associated with plantar fasciitis, though are not the cause of pain most of the times. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs have foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Symptoms

The most common symptoms of plantar fasciitis include:

• Pain on the bottom of the foot near the heel
• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking
• Greater pain after (not during) exercise or activity.

Examination

Examination would reveal,

• A high arch or flat feet
• An area of maximum tenderness on the bottom of your foot, just in front of your heel bone
• Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down
• Limited "up" motion of your ankle.

Treatment

Conservative: Conservatively patient can be managed with physiotherapy, which may include cold therapy, contrast bath or hot fermentation depending upon the pain, stretches (plantar fascia and calf), and myofascial release. Ultrasonic therapy and LASER have proved beneficial in the management of plantar fasciitis. Muscle stimulation can be implemented in cases of flat feet.

Home regime: 
It may include ice rolling for 15-20 minutes, avoiding activities that increase the pain, self stretch techniques several times in a day, strengthening the sole muscles, balance exercises as shown in the picture above.

Nonsteroidal anti-inflammatory medication: 
Drugs such as ibuprofen or naproxen reduce pain and inflammation.

Cortisone Injections: 
Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain.

Supportive shoes and orthotics:
Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.

Night splints:
 Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone.

Surgical treatment: 

we shall not discuss the surgical procedure.

Surgery is considered only after 12 months of aggressive nonsurgical treatment.

For any query or treatment for plantar fasciitis contact...

Pain Free Physiotherapy Clinic

31 A, DDA Flats, Pocket II, Behind sector 6 Market,
Dwarka, New Delhi 110075