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Wednesday, November 15, 2017

Plantar Fasciitis- Part 1 of 2

What is the Plantar fascia?

The Plantar fascia is a thick fibrous band of connective tissue situated on the sole of the foot. The Plantar fascia is not a muscle. It originates from a narrow attachment on the inside portion of the calcaneus (heel bone) and travels forwards and outwards to its broad attachment on the whole length of the ball of the foot. It is triangular in shape.

What is the Plantar fascia’s normal function?

The Plantar fascia acts to stop the over flattening of the arch of the foot.

What is Plantar Fasciitis?

Recently, “Plantar Fasciopathy” is the correct medical term used to the process of micro tears or irritation of the Plantar fascia. For the purpose of this blog though, we are going to use the term “Plantar Fasciitis” as this condition is more commonly known. Typically this occurs at the origin of the Plantar fascia around the heel or in the middle of plantar fascia structure.

What causes Plantar Fasciitis?

Plantar fasciitis is usually caused by either an ongoing tractioning (sustained over stretching) or compression (squashing) of the area.

There are several factors that can lead to this traction or compression of the Plantar fascia:

Poor Foot mechanics– This can include excessive foot pronation or “flat feet” causing an elongated foot arch ie over stretching. It can also include weak intrinsic muscles of the foot (Intrinsic muscles) causing weak arches.

Poor lower limb mechanics– This can include but is not exclusive to tight Achilles tendons, weak Gluteal muscles or a “knocked knee” posture. As a result of these muscle imbalances, the Plantar fascia has to work harder and is therefore overloaded.

 

 

Poor footwear– This is generally due to a lack of arch support in footwear such as thongs (flip flops) or fashion shoes like Converse or Vans. This causes an over stretching of the Plantar fascia and symptoms can ensue. Another contributing factor to Plantar fascia is wearing shoes with hard innersoles such as formal shoes- this causes prolonged compression of the Plantar fascia. Finally, high heels are not recommended when someone is suffering from Plantar Fasciitis as the extra heel height causes compression of the Plantar Fascia.

Environmental factors– Plantar fasciitis is more common in people who stand all day and therefore compression of the plantar fascia results and the Plantar Fascia is not allowed to rest. Alternatively, somebody who is very active and partakes in regular sport (particularly toe running sports such as running) can suffer from Plantar fasciitis.

Bony spurs on heel bone– Calcaneal (heel bone) spurs or calcification can occur as the Plantar fascia has pulled on its attachment to the Calcaneus for a long time as its been overstretched. This can then in turn irritate the Plantar Fascia due to compression.

 

 

Trauma– Stepping on a sharp, hard object such as a stone or a nail for example can result in an insult to the Plantar fascia and Plantar fasciitis results.

Weight– The heavier a person is, invariably the more weight goes through the soles of their feet and the Plantar fascia reaches a tipping point where the amount of load it is put under exceeds the capacity that it can cope with. This is when pain results. Furthermore, during pregnancy the combination of increased weight and the inevitable laxity of ligaments due to the hormone relaxin being released results in an over stretching of the Plantar fascia and symptoms can result.

Furthermore, Diabetes is more common in people who are overweight, so they often
experience Plantar Fasciitis pain due to increased load going through their heel and
therefore compressing the Plantar fascia origin.

Age– As we get older, the quality of our Connective Tissue can deteriorate and this often results in our foot arches sagging or collapsing. This sagging makes Plantar fasciitis more likely.

Symptoms

  • Symptoms are generally felt as an ache or sharpness on the inside aspect of the heel on the sole of the foot.
  • The pain can sometimes spread forward and out towards the ball of the foot.
  • These afore mentioned areas are usually also tender to the touch.
  • The pain is also at its worst, first 15-30 minutes in the morning when getting out of bed and after exercise or prolonged walking.
  • Typically, a person who is experiencing Plantar fasciitis will say that it feels like they are walking on broken glass particularly when they first get out of bed in the morning.

Diagnosis

Physiotherapy Assessment

At Fix Physio we undertake a detailed assessment of how the person stands and walks initially, in particular looking at their foot posture. We look at the foot to see if there is any swelling around the heel or the rest of the sole of the foot. We will then assess how all the joints of their foot, ankle, knee & hip move. After that we look at muscle imbalances- for example is one muscle tight, does it have reduced muscle bulk or is it weaker. Then we palpate the soft tissues to see how they feel, which areas are tender to touch, which areas feel thickened and so on.

Once we’ve put all these finding together, we give our patient an accurate diagnosis of their injury as well as explaining to them the cause of these symptoms and what we need to do as well as giving approximate time scales for recovery.

X-ray/ Ultrasound scan (USS)/ MRI

For Plantar Fasciitis, these additional investigations are only required on the rare occasions when Physio is not helping. An Xray is necessary if you are suspecting a bony spur on the heel bone (calcaneus) or calcification of the Plantar fascia itself. An ultrasound scan or an MRI may be necessary to identify any tears in the Plantar fascia- particularly if you are considering doing Shockwave treatment (see below in Treatment) as this form of treatment is not advised if there are tears in the Plantar fascia. The USS or MRI will also show any areas of thickening or inflammation in the Plantar Fascia.

Look out for Part 2 of 2 of our Plantar Fasciitis blog coming soon which focuses on “How to treat Plantar Fasciitis”.

If you or someone you know is struggling with Plantar Fasciitis, call (02) 9231 0420 or book online at Fix Physio online booking to start your journey to……

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