Plantar fasciitis is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis.[1] The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes. It has been reported that plantar fasciitis occurs in two million Americans a year and 10% of the population over a lifetime.[2] It is commonly associated with long periods of weight bearing. Among non-athletic populations, it is associated with a high body mass index.[3] The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is increased probability of knee pains, especially among runners.
Diagnosis
The diagnosis of plantar fasciitis is usually made by clinical examination alone.[4][5] The clinical examination may include checking the patient’s feet and watching the patient stand and walk. The clinical examination will take under consideration a patient's medical history, physical activity, foot pain symptoms and more. The doctor may decide to use Imaging studies like radiographs, diagnostic ultrasound and MRI.An incidental finding associated with this condition is a heel spur, a small bony calcification, on the calcaneus heel bone, in which case it is the underlying condition, and not the spur itself, which produces the pain. The condition is responsible for the creation of the spur, the plantar fasciitis is not caused by the spur.
Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis. Some current studies suggest that plantar fasciitis isn't actually inflamed plantar fascia, but merely an inflamed Flexor digitorum brevis muscle belly. Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.[citation needed]
Treatment
Treatment options for plantar fasciitis include rest, massage therapy, stretching, night splints, motion control running shoes, physical therapy, Cold therapy, orthotics, anti-inflammatory medications, injection of corticosteroids and surgery in refractory cases.===========
http://www.webmd.com/a-to-z-guides/plantar-fasciitis-topic-overview
What causes plantar fasciitis?
Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:- Your feet roll inward too much when you walk (excessive pronation
).
- You have high arches or flat feet.
- You walk, stand, or run for long periods of time, especially on hard surfaces.
- You are overweight.
- You wear shoes that don't fit well or are worn out.
- You have tight Achilles tendons or calf muscles.
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http://www.sportsinjuryclinic.net/cybertherapist/front/foot/plantarfaciitis.htm
What are the symptoms?
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.If you have foot pain at night, you may have a different problem, such as tarsal tunnel syndrome.
What Causes Plantar Fasciitis?
The most common cause of plantar fasciitis is very tight calf muscles which leads to prolonged and / or high velocity pronation of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength.Some practitioners think overpronation can always be determined by the dropping and rolling in of the arch. This is not always the case. Sometimes it can only be seen with foot scans, especially if the patient has a high arched foot.
Other causes include high arch or low arch feet (pes cavus / planus) and other biomechanical abnormalities including oversupination which should be assessed by a podiatrist / physiotherapist / biomechanist.
Excessive walking in footwear which does not provide adequate arch support has been attributed to plantar fasciitis. In addition, overweight individuals are more at risk of developing the condition due to the excess weight impacting on the foot.
More information on the biomechanics of plantar fasciitis is available free to view here on sportsinjuryclinic.net.
Plantar Fasciitis Treatment
What can the athlete do?
- Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation. Rest as much as possible and stop any unnecessary activities which place additional stress on the fascia.
- A good plantar fasciitis taping technique can help the foot get the rest it needs by supporting the plantar fascia. Tape is applied in strips across the plantar fascia taking the stress off the foot which healing to take place.
- Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved.
- Stretching the plantar fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The plantar fascia tightens up making the origin at the heel more susceptible to stress.
- A plantar fasciitis night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.
http://orthoinfo.aaos.org/topic.cfm?topic=a00149
Nonsurgical Treatment
More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.
Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics).Ice. Rolling your foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.
Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the medication for more than 1 month should be reviewed with your primary care doctor.
Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
- Calf stretch
Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. - Plantar fascia stretch
This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.
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Plantar Fasciitis — plantar Fasciitis is the most common condition of heel pain. This condition occurs when the long fibrous plantar fascia ligament along the bottom of the foot develops tears in the tissue resulting in pain and inflammation. The pain of plantar fasciitis is usually located close to where the fascia attaches to the calcaneous, also known as the heel bone. The conditions is often mispelled as: plantar fascitis, plantar fasciatis, planters fasciitis, plantar faciatis, and plantar faciaitis. Correctly pronounced it is "plantar fash-eee-eye-tiss".
Plantar fasciitis causes the inflammation of the plantar fascia ligament which runs along the bottom of the foot. The plantar fascia ligament is made of fibrous bands of tissue and runs between the heel bone and your toes and stretches with every step. Inflammation develops when tears occur in the tissue.
The most common complaint from plantar fasciitis is a burning, stabbing, or aching pain in the heel of the foot. Most sufferers will be able to feel it in the morning because the fascia ligament tightens up during the night while we sleep, causing pain to diminish. However, when we climb out of bed and place pressure on the ligament, it becomes taut and pain is particularly acute. Pain usually decreases as the tissue warms up, but may easily return again after long periods of standing or weight bearing, physical activity, or after getting up after long periods of lethargy or sitting down.
In most cases, plantar fasciitis does not require surgery or invasive procedures to stop pain and reverse damage. Conservative treatments are usually all that is required. However, every person's body responds to plantar fasciitis treatment differently and recovery times may vary.
There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage.
Another common cause of plantar fasciitis is arthritis. Certain types of arthritis can cause inflammation to develop in tendons, resulting in plantar fasciitis. This cause is particularly common among elderly patients. Diabetes is also a factor that can contribute to further heel pain and damage, particularly among the elderly.
Among the most popular factors that contribute to plantar fasciitis is wearing incorrect shoes. In many cases, shoes either do not fit properly, or provide inadequate support or cushioning. While walking or exercising in improper shoes, weight distribution becomes impaired, and significantly stress can be added to the plantar fascia ligament.
In many instances, plantar fasciitis can be treated with home care. Changing your physical activities, resting the foot, and applying ice to the area are common remedies. Taking over the counter medications such as ibuprofen or acetaminophen can help reduce pain and inflammation that may have developed. An orthotic device placed in your shoes can also significantly help to reduce pain. In addition, orthotics can also help promote healing to reverse plantar fasciitis.
If pain from plantar fasciitis continues despite conservative treatments, you may need to visit a doctor or podiatrist. It's important to seek medical advice before heel pain and damage becomes worse. If the condition is allowed to worsen, more serious or invasive forms of treatment may be required to stop pain. A visit to a doctor may reveal other conditions affecting the foot as well, such as Achilles tendonitis, heel spurs, or other heel pain conditions. An x-ray may also be taken, which can reveal the presence of a heel spur. In rare cases surgery may be required to release tension on the plantar fascia, or to remove a portion of a heel spur. But again, most heel pain conditions can be resolved using conservative treatment.
Again, prolonging treatment for plantar fasciitis will cause the condition to become worse. In some cases, a mild aching can evolve into a chronic problem. Another common problem is a change in your gait in order to counteract pain during movement. As a result of these involuntary changes in the foot's mechanics, knee, hip, or back pain can also develop.
Treatment for plantar fasciitis should begin with rest, icing, and over the counter medications. As mentioned above, an orthotic is a device that can be slipped into any pair of shoes and can often relieve pain and help to reverse the damage and occurrence of plantar fasciitis. They do this by adding support to the heel and helping to distribute weight during movement. In addition to orthotics, many people consider night splints for treating this condition. These devices are worn during the night while you sleep, helping to keep the plantar fascia stretched to promote healing. Physical therapy has also become a common option. With this conservative treatment alternative, a physical therapist designs a set of exercises that are intended to address your specific needs in order to promote healing.
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