The plantar fascia is a dense, fibrous membrane which forms a strong mechanical tie between the heel and toes. The plantar fascia maintains the arch of the foot. Plantar Fasciitis refers to the inflammation of the plantar fascia and usually occurs due to repetitive stress. It is most commonly seen in people who are active in walking, standing and especially running. Occasionally, Plantar Fasciitis occurs in people who have had an acute injury to the area, a change in footwear, or a change in weight. The plantar fascia is sometimes pulled away from the bone and the body will deposit bone to repair the area. The bone deposit or heel spur is often seen on an x-ray and is a sign of the underlying problem.
Plantar Fasciitis, also known as heel pain syndrome, is the inflammation of the plantar fascia. It usually starts as a dull, intermittent pain in the heel area and may progress to a sharp, constant pain. Typically, Plantar Fasciitis pain is worse in the morning or during the first few steps of an activity and may ease initially and then worsen throughout the day.
Signs and Symptoms
Heel and/or arch pain, especially when first standing after a period of rest
Swollen heel
Bony spur on x-ray
Contributing Factors
Overpronation or flat feet
Over-supination or rigid feet
Poor footwear
Tight Achilles tendon
Obesity or sudden weight gain
Overuse, prolonged standing
Treatment/Prevention
Treatment is based on a correct diagnosis by the physician. Once the problem is diagnosed, the physician usually sets up a treatment plan which may include the following.
Appropriate Footwear:
Shoes should be selected according to specific activities, foot structure and individual wearer characteristics. The person with Plantar Fasciitis should always wear shoes or supportive sandals such as Birkenstocks or Mephistos.
Orthotic Intervention
The use of foot orthoses (inserts) are often required for the treatment and prevention of Plantar Fasciitis. Orthoses are available pre-fabricated or custom made. A thorough biomechanical assessment allows the Certified Orthotist to determine if and what type of orthosis is most appropriate for the individual client.
Ice
Icing the heel several times a day will help reduce inflammation. Take care to protect the skin from frostbite.
Modified Activity
Decreasing the repetitions of stress on the inflamed fascia will reduce the destructive forces and help prevent further injury. Changing the activities to reduce load through the foot also reduces chances of re-injury. For example, running can temporarily be replaced by cycling.
Physiotherapy
Physiotherapy may be prescribed. Initially, therapy will focus on reducing inflammation and then to increase flexibility and strength in order to prevent reoccurrence. Gentle stretching of the Achilles tendon and plantar fascia several times a day will help to prevent further injury.
Other
Cortisone, medication, shock wave therapy, casting and surgery are also used in some cases.
