Plantar Fasciitis

Plantar fasciitis is a painful condition affecting the bottom of the foot and continues to be one of the more frustrating injuries common to the runner. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration of the plantar fascia after long standing plantar fasciitis. Runners often alter how they run in order to continue through plantar fascial pain by shortening stride length, changing position of foot strike, or running on the outside border of the foot. These adaptations may lead to other problems further up the kinetic chain as the body compensates for the changes. Taking proper care of plantar fasciitis is important to prevent both further injury and longstanding problems with the plantar fascia itself.

ANATOMY

The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue running from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer's bow. It helps give support to the joints, bones, and muscles of the foot and it creates a rigid lever for push-off. It is this tissue that is the source of the painful condition plantar fasciitis.

Both the plantar fascia and the Achilles' tendon attach to the calcaneus, and although they function separately, there is an indirect relationship. If the toes are pulled back toward the face, the plantar fascia tightens up, and this position is very painful for someone with plantar fasciitis. Force generated in the Achilles’ tendon increases the strain on the plantar fascia.

CAUSES

Plantar fasciitis can come from a number of underlying causes and finding the precise reason for the heel pain is sometimes difficult.

As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone and small tears in the fascia can result. These tears are normally repaired by the body.As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body's response to try to firmly attach the fascia to the heel bone. As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption and this is an additional factor that might lead to plantar fasciitis. In many cases, the actual source of the painful heel may not be defined clearly.

SYMPTOMS

The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot.

This is usually most pronounced in the morning when the foot is first placed on the floor and after periods of inactivity.

NON-SURGICAL REHABILITATION

Non-surgical management of plantar fasciitis is successful in 90 percent of all cases. A Rehabilitation team including therapists such as a Physiotherapist, Chiropractor, or Massage Therapist is a great place to start for a program that is designed specifically for you and your injury.Therapy should include exercises to improve flexibility in the calf muscles, Achilles' tendon, and the plantar fascia, as well as treatments to the painful area to help control pain and swelling. Examples include ultrasound, ice packs, and soft-tissue massage or Active Release Technique (ART®). Other treatment options include acupuncture to increase local blood flow to the area, and Graston Techniques, which uses a stainless steel instrument to help break up adhesions and help to re-align the fibers of the plantar fascia.

Depending on a number of factors including the chronic nature of the problem, you may require a customized arch support, or orthotic, designed to support the arch of your foot and to help cushion your heel. Supporting the arch with a well fitted orthotic may help reduce pressure on the plantar fascia. Alternatively, a special type of insert called aheel cup can be placed in the shoe to reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration. You may also be fit with a night splint to wear while you sleep or taping can be done to help support the plantar fascia. The night splint keeps your foot from bending downward and places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint and report having less heel pain when placing the sore foot on the ground in the morning.

Your doctor may order an X-ray to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and diagnostic ultrasound. Anti-inflammatory medications are sometimes used to decrease the inflammation in the fascia and reduce pain.A Cortisone injection into the area of the fascia may be used but has not been proven effective. Cortisone should be used sparingly since it may cause rupture of the plantar fascia, as well as fat pad degeneration and atrophy, making the problem worse.

Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It's possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.

Many times it takes a combination of different approaches to get the best results for patients with plantar fasciitis. Finding the right combination for you may take some time. Don't be discouraged if it takes a few weeks to a few months to find the right fit for you. Most of the time, the condition is self-limiting, which means that it doesn't last forever but does get better with a little time and attention. In some cases, however, it can take up to a full year or more for the problem to be resolved and having a good Medical Doctor and Rehabilitation team is invaluable to quick and effective return to a normal running schedule.

Moveo Sport and Rehabilitation Centre

101-135 15th Street East
North Vancouver, BC V7L 2P7
(604) 984-8731

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