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Plantar Fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is one of those conditions that if you’ve had it, you will never forget it. It is easily the most common musculoskeletal condition that podiatrists see and treat.  It is not well outside of the population who have suffered from it previously.

So what is it? And more importantly, how the heck do you say it? Plantar fasciitis (pronounced “fash-ee-eye-tis”) refers to an inflammation of the plantar fascia. A strong band of tissue that runs along the bottom of your foot. It runs from your heel (calcaneus) to the ball of your foot (metatarsal-phalangeal joints).

This structure is important in shock absorption, maintaining the arch height, and providing the mechanism by which you push off to take a step. When this structure undergoes excessive strain over long periods of time it can become inflamed. Often near its attachment at the heel bone. Over time, this site can become progressively more and more painful to put weight on the heel of the foot.

The heel pain experienced with plantar fasciitis is typically worst in the first few steps following rest. Especially first thing in the morning! In its early stages the pain can fade throughout the day. If it is ignored, the condition can get worse. It may get to the point where any activity on the feet can be very painful.

What causes it?

Plantar fasciitis is a condition brought about by overuse. It occurs in members of the population who experience excessive forces through their feet. This include athletes – especially runners and people who are overweight. It also includes people whose jobs require them to spend long periods of time on their feet.

Poor footwear may also exacerbate the condition. Your foot shape and the individual mechanics of your foot can play a big part in its cause. Abnormal movement of the small muscles in your foot plays a part in causing this condition, and some publications believe very high or very flat arches may also contribute to its cause.

Read more on the foot pain of plantar fasciitis and the cause of it on our podiatry blog.

Diagnosis

The use of diagnostic imaging may be helpful in identifying plantar fasciitis. Ultrasound is usually the most effective way to see the tell-tale swelling of the plantar fascia.

X-rays are also often used and may show a small outcropping of bone (or spur) at the bottom of the heel where the pain is located. Research shows that whilst a heel spur may be related to the tension placed on the muscles and fascia of the bottom of the foot, a spur are not thought to be the cause of pain. X-rays of healthy, pain-free feet often demonstrate heel spurs without any negative effects. As a result, the presence of a heel spur in an x-ray does not conclusively diagnose plantar fasciitis.

Usually when a patient comes in with plantar fasciitis, they don’t care about any of this. They just want to fix it. So how do we treat it?

Management

Plantar fasciitis responds fairly well to treatment as a general rule. In saying that, it is important to remember that the longer the condition has been around, the longer it will often take to heal. In the short term, ice massage with a frozen water bottle can help at times where the condition has flared up. Before getting out of bed in the morning, stretch and move the foot.

One exercise I particularly like is to trace the outline of all of the letters of the alphabet in the air using your big toe and foot. Regular stretching of the muscles in the foot and leg, such as the calf, can help as well. Resting from excessive activity should help settle it, or your podiatrist can also show you how to strap the foot effectively.

Long term treatment requires an understanding of what caused the plantar fasciitis in the first place. If  related to poor foot biomechanics or structure, a podiatrist can help with appropriate footwear advice and stretching regimen.

Foot orthotics have been shown to be extremely effective at managing plantar fasciitis for the long term, and again your podiatrist can assist with developing an orthotic device to assist in eliminating unwanted strain through the plantar fascia.

Read more on the management of plantar fasciitis and how the foot pain of plantar fasciitis needs to be treated by a podiatrist or physiotherapist.