What is Plantar Fasciitis?
Plantar fasciitis is one of the most common sources of heel pain.
Your 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 toes.
Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.
What Causes Plantar Fasciitis?
Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods.
They are either traction or compression injuries.
Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles.
It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.
Traction Plantar Fasciitis
Plantar fasciitis symptoms are usually exacerbated via "traction" (or stretching) forces on the plantar fascia. In simple terms, you plantar fascia is repeatedly overstretched. The most common reason for the overstretching are an elongated arch due to either poor foot biomechanics (eg overpronation) or weakness of your foot arch muscles.
Compression Plantar Fasciitis
Compression type plantar fascia injuries have a traumatic history. Landing on a sharp object that bruises your plantar fascia is your most likely truma.
The location of plantar fasciitis pain will be further under your arch than under your heel, which is more likely to be a fat pad contusion if a single trauma caused your pain.
The compression type plantar fasciitis can confused with a fat pad contusion that is often described as a "stone bruise".
What are the Symptoms of Plantar Fasciitis?
You'll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting.
Your heel pain will be worse with the first steps and improves with activity as it warms up.
How Does Plantar Fasciitis Progress?
As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines:
- No Heel Pain - Normal!
- Heel pain after exercise.
- Heel pain before and after exercise.
- Heel pain before, during and after exercise.
- Heel pain all the time. Including at rest!
This symptom progression is consistent with the four stages of a typical overuse injury.
Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone it is known as heel spurs, which have a longer rehabilitation period.
How is Plantar Fasciitis Diagnosed?
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination.
After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts.
X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur.
Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.
Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Risk Factors for Plantar Fasciitis
You are more likely to develop plantar fasciitis if you are:
Active - Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. Running, ballet dancing and aerobics.
Overweight - Carrying around extra weight increases the strain and stress on your plantar fascia.
Pregnant – The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation.
On your feet – Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses.
Flat Feet or High Foot Arches – Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.
Middle-Aged or Older – With ageing the arch of your foot may begin to sag – putting extra stress on the plantar fascia.
Wearing shoes with poor support.
Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury.
Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.
Plantar Fasciitis Treatment
The good news is that plantar fasciitis is reversible and very successfully treated. About 90 percent of people with plantar fasciitis improve significantly within two months of initial treatment.
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