Plantar
The plantar fascia is a band of tissue on the sole of the foot that supports the arch of the feet.
It runs from your heel to your toes and functions as a shock absorber when we move.
Plantar fasciitis is one of the most common causes of heel pain caused by inflammation of your plantar fascia.
How do I know if I have plantar fasciitis?
• Stabbing pain in the bottom of your foot near the heel
• Pain is usually the most intense in the morning when you take your first step out of bed, then the pain decreases
• It can also be triggered by long periods of standing or when you get up after prolonged sitting.
• Pain typically occurs just after activity/exercise
What are the causes of plantar fasciitis?
Our plantar fascia is in the shape of a bowstring, supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this bowstring become too great, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia..
Who is at risk of getting plantar fasciitis?
Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:
Age. Plantar fasciitis is most common between the ages of 40 and 60.
Certain types of exercise that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis.
Foot mechanics. Flat feet, a high arch or even an abnormal pattern of walking can affect the way weight is distributed when you are standing and can put added stress on the plantar fascia. Wearing shoes with soft soles and poor arch support can also result in plantar fasciitis.
Excess weight puts extra stress on your plantar fascia, such as women who are in their late pregnancy or those who are overweight/obese.
Occupations that keep you on your feet such as factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces may damage the plantar fascia.
How is plantar fasciitis diagnosed and investigated?
A typical history of heel pain that is worse in the morning which gets better with stretching and walking is often enough for your doctor to diagnose plantar fasciitis. Imaging such as x-rays or MRI scans are usually not necessary unless your doctor would like to exclude other conditions such as a stress fracture.
X-rays sometimes show a bone spur in the heel and there is often a misconception that it is the spur that causes the pain. There are lots of people with the bone spurs who do not have any heel pain in the community.
What can happen if plantar fasciitis is left untreated?
Neglected plantar fasciitis may result in chronic heel pain that hinders your regular activities and compromise the way you walk. Compensatory walking patterns may then lead to other joint problems such as knee, hip or back pain.
Treatment options for plantar fasciitis
Initial selfcare with ‘RICE’ (Rest, Ice, Compression, Elevation) and anti-inflammatory medication (Ibuprofen/Arcoxia) are often effective ways to treat plantar fasciitis. Regular stretching of your calf, hamstring and foot are crucial to allow a relief of symptoms.
Night splints worn at night work to hold the plantar fascia and Achilles tendon in a lengthened positions overnight to promote stretching. This helps to prevent morning heel pain.
Other ways to reduce the pain of plantar fasciitis include the following:
How Are Ankle Treatments Performed?
1
Maintain a healthy weight to reduce stress on your plantar fascia.
2
Choose supportive shoes with good arch supports and cushions. Do not wear worn out shoes with poor arch supports.
3
Stretch the arches of your foot
4
Consider changing to a low impact sport such as cycling and swimming instead of running or jogging.
Procedures to treat Plantar Fasciitis
Physiotherapy
Physiotherapy is a key part of treatment for plantar fasciitis. It can help stretch your plantar fascia and Achilles tendons. A physiotherapist can show you exercises to strengthen your lower leg muscles, helping to stabilize your walk and lessen the workload on your plantar fasci.
Injections
If conservative measures are not working after several months of treatment, injections to the painful area have been shown to improve pain and function. These include a combination of a local anaesthetic and small dose of steroids, or platelet rich plasma (PRP). Your orthopaedic surgeon may use an ultrasound device to help determine the best place for the injection.
If conservative measures are not working after several months of treatment, injections to the painful area have been shown to improve pain and function. These include a combination of a local anaesthetic and small dose of steroids, or platelet rich plasma (PRP). Your orthopaedic surgeon may use an ultrasound device to help determine the best place for the injection.
Extracorporeal shockwave therapy (ESWT)
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment modality which directs sound waves to the painful area to stimulate healing. ESWT has been shown to be effective in chronic cases of plantar fasciitis.
Surgery
Surgery is often the last resort for chronic plantar fasciitis which has failed to respond to other forms of treatment. During a plantar fascia release, your surgeon partially detaches the plantar fascia from the heel bone either as an open procedure or through a small incision. If your surgeon finds your calf or gastrocnemius muscles tight and contributing to your plantar fasciitis, he may recommend gastrocnemius recession. This procedure involves lengthening the calf muscle to increase ankle motion and release stress on the plantar fascia.
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