The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus and runs forward to form the longitudinal foot arch. The function of the plantar fascia
is to provide static support of the longitudinal arch and dynamic shock absorption. Individuals with pes planus (low arches or flat feet) or pes cavus (high arches) are at increased risk for
developing plantar fasciitis.
Currently no single factor has been reliably identified as contributing to the development of plantar fasciitis. The two risk factors with the most support from current research. Decreased ankle
dorsiflexion. Increased Body Mass Index (BMI) in non-athletic populations. These factors are related in that both lead to increased strain on the arch, both lead to increased compression on the heel.
When dorsiflexion range of motion (ankle flexibility) is lacking, the body compensates by increasing movement of the arch. In this way, decreased ankle dorsiflexion influences pronation and places
strain on the underside of the foot. Similarly, having a high BMI causes strain because it places a load on the foot that may be in excess of what the foot can support. As mentioned earlier,
overpronation is thought to be a contributing factor, but studies on this have so far produced mixed results. The second way these factors relate to each other is in the way people stand. A lack of
ankle flexibility and a high BMI can both cause increased pressure on the heel in standing. Keeping weight on the heels causes compression under the heel. But it also means the muscles and ligaments
in the arch are not being used to balance your body weight. Lack of use, I suspect, is a greater danger than overuse. Looking beyond these potential contributors to heel pain though, there is one
major factor that overshadows them all-the way footwear alters the normal function of the foot.
Heel pain is the most common symptom associated with plantar fasciosis. Your heel pain may be worse in the morning or after you have been sitting or standing for long periods. Pain is most common
under your heel bone, but you also may experience pain in your foot arch or on the outside aspect of your foot. Other common signs and symptoms of plantar fasciosis include mild swelling and redness
in your affected area, tenderness on the bottom of your heel, impaired ability to ambulate.
Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the
symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.
Non Surgical Treatment
The key for the proper treatment of plantar fasciitis is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with
rearfoot posting and longitudinal arch support is an effective device to reduce the over-pronation and allow the condition to heal. If you have usually high arches, which can also lead to plantar
fasciitis, cushion the heel, absorb shock and wear proper footwear that will accommodate and comfort the foot. Other common treatments include stretching exercises, plantar fasciitis night splints,
wearing shoes that have a cushioned heel to absorb shock, and elevating the heel with the use of a heel cradle or heel cup. Heel cradles and heel cups provide extra comfort, cushion the heel, and
reduce the amount of shock and shear forces placed during everyday activities.
In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel
spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic
plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same
place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example,
the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that
allow blood supply in the area. This will increase the time of recovery.
Stretching the plantar fascia and the calf muscle area can help to prevent inflammation. Slowly increasing the amount or intensity of athletic activities by graded progression can also help to
prevent injury. Recommended Stretches: Taking a lunge position with the injured foot behind and keeping your heels flat on the floor, lean into a wall and bend the knees. A stretch should be felt in
the sole and in the Achilles tendon area. Hold the stretch for 20-30 seconds. Also try this stretch with the back leg straight.