What is Plantar Fascitis?
Plantar fasciitis is the most common cause of foot and heel pain. In fact, research suggests that as many as 1 in 10 individuals may develop plantar fasciitis in their lifetime.
The plantar fascia is a thick band of connective tissue that runs along the sole of the foot from the heel at the back to base of the toes (metatarsals) at the front. The main function of this fascia is to support the arches of the feet like a hammock. It provides the bounce to the arches while we walk, propelling us forward. With time, there may be small tears in this fascia giving rise to pain while walking.
Plantar fasciitis is a sharp heel pain that occurs around the heel & can radiate along the bottom of the foot along the course of the plantar fascia. The pain of plantar fasciitis is increased with activity that loads or stretches the plantar fascia. Plantar fasciitis can also be characterised by morning pain. It is an overuse condition more commonly affecting runners. People who need to stand for a long time are also more likely to develop this condition.
Plantar fasciitis is more of a degenerative condition due to overuse as opposed to inflammatory in nature.
A calcaneal (heel) spur may develop in areas of the heel where forces are increased due to tight muscles and faulty biomechanics. During toe off tightening of the plantar fascia raises the longitudinal arch of the foot & assists in propelling the foot forward during running or walking.
Causes of Plantar Fascitis
There are many theories regarding the causes of plantar fasciitis. One is that altered foot mechanics as occurs with flatfoot (over pronation) can give rise to repetitive overload of the plantar fascia & that this may give rise to pain. Plantar fasciitis is particularly common in runners and overweight individuals where the loading of the foot is increased. Although heel spurs are commonly seen in such patients, these are normally a response to chronic overload rather than being the instigator of symptoms.
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Who is at risk of Plantar fasciitis?
Age:Plantar fasciitis is more commonly seen in the age group of 40-50 years of age. This is attributed to overuse and overload through the years.
Runners:Plantar fasciitis is more commonly seen in runners. While running the plantar fascia is put on a stretch as the mid foot flattens and the toes are extended upwards. Repeated stretch during walking and running causes injury to the plantar fascia.
Overweight:70% of obese people are at increased risk of plantar fasciitis according to research. This applies to non-exercising individuals. The increased body weight flattens the arches of the foot, stretching out the plantar fascia more than usual. Middle aged obese females are more vulnerable to plantar fasciitis.
Flat foot:People who have biomechanical malalignments like flat foot or even high arch foot are at risk for developing plantar fasciitis. Both this foot deformities put greater strain on the fascia causing it to weaken and tear.
Foot alignment and flexibility: Research has shown that individuals with reduced mobility around the ankle are more prone to plantar fasciitis. If the ankle is stiff, the plantar fascia has to stretch out more to allow greater push off through the toes while walking and running.
The same theory applies to 80% of the people having tight calf muscles who go on to develop plantar fasciitis.A tight calf muscle contributes to a stiff ankle.
Strength issues: Weakness in the foot evertors (muscles that turn the foot outwards) and toe flexors (foot curl) also contribute to increased risk of plantar fasciitis.Imbalance in opposing muscle groups means the plantar fascia has to stretch more to accommodate uneven foot positions making it prone to injury.
Heel Spur: Heel spurs are another common cause of foot pain that are often seen to coexist with plantar fasciitis.A heel spur is an outgrowth of the heel bone in the region of attachment of plantar fascia.These are normally a response to chronic overload rather than being the instigator of symptoms. This is a really important concept, as most people perceive that the bone growth is the source of their pain as opposed to being a result of the abnormal forces that are causing their pain. In other words, most people develop a heel spur from excessive loading of the area and it is the excessive loading and not the bony growth that causes symptoms.
Symptoms of Plantar fasciitis:
Morning pain is the classic symptom of plantar fasciitis. During the night, the fascia gets shortened. Thus, the first step in the morning is painful as the fascia is stretched out (creep) under the body weight. The pain eases as you walk around. If the pain lasts over 10 minutes then this indicates a more severe condition that will take longer to heal.
The foot pain becomes worse after walking, standing or running continuously for a long time. The inner arch of the foot is painful to touch, especially near the heal.
Physiotherapy treatment for Plantar fasciitis
Short-term management of plantar fasciitis may include taping to offload the sole of the foot.
Calf stretches done 3-5 times a day also help to relieve plantar fascia pain and improve foot mobility. These must be combined with physiotherapist applied joint mobilisation techniques that improve overall foot mobility.
Night splints have proven to be effective in minimising morning pain. Splints worn at night keep the foot in neutral position. As a result, the plantar fascia does not shorten at night. This makes the morning first step relatively pain free.
Deep tissue massage of the plantar fascia performed by a skilled physiotherapist is yet another way to enhance flexibility of the fascia. The deep pressure applied in circular and longitudinal directions loosens the scar tissue.
Improving strength in the calf and foot muscles helps to improve foot mobility and reduces strain on the plantar fascia. Simple exercises like curling the toes or pushing the ball outwards with the foot are an effective starting point to activating these muscles.
Identifying the underlying biomechanical factors that are giving rise to plantar fascia overload is critical to attaining long-term success and for prevention of reoccurrence.
Your physiotherapist will assess you in order to identify the main drivers of your pain and devise a tailored rehabilitation programme to reduce symptoms & offload the sole of the foot. Physio interventions will include strengthening exercises & manual therapies including joint mobilisations & muscle release techniques.
To find out more regarding Plantar Fascitis call Naas Physio Clinic on:
(045) 874 682
or email us at email@example.com
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