Plantar Fasciitis

WHAT IS IT?

  • inflammation (ITIS) of the dense fibrous sheath of the sole of the foot;
  • running from the heel, crossing the ball of the foot (PLANTAR FASCIA)

WHAT DOES THE FASCIA DO?

  • absorbs shock
  • adapts the foot to changes in terrain
  • facilitates foot push off

WHAT HURTS?

  • tender inside bottom of heel, may have diverse discomfort over rest of heel into arch
  • often one sided
  • morning pain and stiffness, pain on standing after prolonged rest
    • early stage: pain after activity
    • middle stage: pain during activity
    • late stage: pain at rest

WHAT SHOWS UP ON X-RAY?

  • 20% of population has heel spurs without symptoms
  • up to 75% of people with heel pain have heel spurs

WHAT CAUSES IT?

  • flat feet (excessive pronation)
  • high arches (excessive supination)
  • leg length discrepancy
  • recent impact trauma
  • calf muscle shortening
  • toe/foot/ankle/knee/hip/pelvis/lumbar spine/or nerve biomechanical problems
  • training errors
    • increase mileage
  • increase in frequency
  • increase in intensity
  • change of footwear or terrain i.e. running up hills

WHY DOES IT HURT?

  • too much flexibility in foot; too much rigidity in foot
  • both result in localized inflammation at the heel that is "squeezed out" with weight bearing
  • at night or rest, inflammation is absorbed into the area, pushing on sensitive nerve endings ~ first morning steps are very painful and stiff until the inflammation is squeezed out and scar tissue is stretched
  • once the inflammation and scarring are present they are difficult to remove

WHAT TO DO ABOUT IT?

  • establish an accurate activity history
  • implement modified/active rest with non-weight bearing activities: swimming, cycling, water running
  • orthotic devices (custom made by certified orthotist) for "pronators" or "supinators"
  • appropriate foot wear
  • mobilizing / stretching shortened structures and strengthening supportive structures as outlined by your physiotherapist
  • correct training errors
  • achieve healthy body weight
  • ice cube massage10 minutes three times a day

RULE OF THUMB

ice decreases inflammation | heat increases inflammation

  • anti-inflammatory medication
  • therapeutic modalities such as ultrasound or
  • interferential current
  • cortisone injection (only as required)

HOW DO I PREVENT IT?

  • custom made orthotics
  • proper shock absorbing footwear
  • stretching/mobilizing potentially restrictive structures
  • appropriate strengthening
  • avoid training errors
  • maintain healthy body weight

WHAT ELSE CAUSES HEEL PAIN?

  • local tendon pain
  • referred muscle pain
  • local ligament pain
  • fat pad degeneration of the heel
  • stress fracture of heel bone (calcaneus)
  • plantar fibromatosis
  • low back (lumbar) disc protrusion with pinched nerve
  • systemic medical conditions: osteoporosis, rheumatoid arthritis

YOUR PHYSIOTHERAPIST CAN HELP YOU WITH THE REST…

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