Plantar fasciitis [Heel Pain Syndrome]

Pain from plantar fasciitis usually occurs in the heel, immediately on standing or starting to walk. The first steps out of bed or after prolonged sitting are the most painful. When this condition first develops, pain often improves or resolves with continued walking and changing shoes. Night heel pain is more likely to be a bone stress fracture or a pinched nerve [nerve entrapment].

Development of Plantar Fasciitis

Plantar fasciitis often develops in younger runners and patients between the ages of 40 and 60 years of age who are often slightly overweight and may be out of shape. Other factors include obesity, recent weight gain, and occupations that require prolonged standing. Usually associated with plantar fasciitis is a tight Achilles tendon or shortened calf muscle [ the gastrocsoleus muscle complex] that may slow or prevent healing of the plantar fascia. Rarely, there is a disease causing inflammation such as spondyloarthropathy or infection.

What is Plantar Fascia?

The plantar fascia is on the bottom of the foot and consists of a fibrous band extending from the heel to the ball of the foot in a fan like pattern that attaches to each toe. Plantar refers to the bottom of the foot and fascia is the name of a fibrous band. This fascia is part of the long arch of the foot. The attachment to the heel bone [calcaneal bone] is the most “fixed” point according to it’s biomechanics. This is where most injuries occur. It is commonly called heel pain or heel spur pain or arch pain. However, it is not generally know that the actual heel spur [cacaneal osteophyte] is painless. Heel spurs occur in 15% to 20% of the pain free population and are absent in many people with plantar fasciitis. Plantar fasciitis often develops in younger runners and patients between the ages of 40 and 60 years of age who are often slightly overweight and may be out of shape. Other factors include obesity, recent weight gain, and occupations that require prolonged standing. Usually associated with plantar fasciitis is a tight Achilles tendon or shortened calf muscle [ the gastrocsoleus muscle complex] that may slow or prevent healing of the plantar fascia. Rarely, there is a disease causing inflammation such as spondyloarthropathy or infection.

Causes of Plantar Fasciitis

Plantar fasciitis may be caused by overuse and/or other biomechanical factors. Overuse results in repetitive tiny tears in the plantar fascia [microtrauma]. The Podiatrist will evaluate for changes in footwear, running on hard surfaces, excessive or increased running distance, or structural conditions such as a high arch deformity [pes cavus], flat foot [pes planus] or a shortened Achilles tendon.

Evaluation of the painful heel

When the Podiatrist evaluates the foot, there is usually a specific point of maximum pain over the inside of the heel or the bottom of the heel and may extend along the long arch [longitudinal arch] of the foot. By pushing the toes up [dorsiflexion of the toes] a general pain may become focused at one point because this stretches the plantar fascia. If pain is located on the back of the heel or with squeezing the palms of the hand over the heel, another condition may be present. Examples are a bone stress fracture, a heel pad disorder, a plantar nerve entrapment (“jogger’s foot”), or periostitis [stone bruise] . A biomechanical evaluation is a specialized evaluation of the mechanical

Management of Plantar fasciitis requires Biomechanical evaluation

BIOMECHANICS includes the study of these relationships and is critical in the management of many foot disorders like bunions . BIO refers to the body and MECHANICS is the way the different parts work together. Keeping things in balance provides for the normal function of the body. Biomechanical abnormalities affecting the leg and thigh, ankle arch and heel are evaluated because they increase the risk of developing plantarfasciitis. Excessive foot rotation and arch stress cause microtrauma [repetitive small injuries] to the plantar fascia . Fasciitis is the resulting weakened fibers, chronic swelling, and inflammation. Additional diagnostic testing is needed when the findings are unclear and in patients who have failed to respond to appropriate treatment.

Treatment

Physical therapy modalities and instruction on a stretching plan are provided. Treatment is most successful with a stepwise plan that is initially very conservative with biomechanical techniques. Examples may include Non-weightbearing stretching exercises to the plantar fascia. Achilles tendon stretching. Avoid wearing flat shoes and walking barefoot. Silicon heel cups, Ultrasound, arch taping, heat, ice massage, and ice baths or packs, night splints, iontophoresis may be added. These modalities are continued for 6 to 8 weeks as needed.

Biomechanical foot orthotics are a prescription made devices that are inserted into the shoes. They are for patients with abnormal biomechanical examinations. For patients who are physically active, recommendations should include temporary avoidance of weightbearing exercises. Nonsteroidal anti-inflammatory medication [ such as motrin or ibuprofen], a short course of corticosteroids, or injections provide pain relief while the condition is healing. For cases resistant to the above measures surgical techniques are performed.