Plantar Fasciitis

 Plantar Fasciitis
                                     
The average person takes about 10,000-15,000 steps a day & running 1 mile results in 800-2000 foot steps

Anatomy: The plantar fascia is a band of virtually non-elastic tissue running the length of the bottom of your foot, functioning  like a bowstring. It is thickest at the heel & broadens out to attach at the base of each toe.
        
Signs & Symptoms:
Heel pain exacerbated by full weight bearing
•     Sharp pain, burning heel pain with walking, running, jumping   
•     A.M. pain with the first steps out of bed
•     Pain after prolonged sitting & then standing up again.  After standing  
      for a  while pain may reduce
•     Palpation tenderness on the inside aspect of the heel bone
•     Localized swelling   

Biomechanics & Pathology:
The cycle of plantar fascia inflammation / pain is frequently caused by prolonged full weight bearing which flattens (pronate) the foot &     over-stretches the fascia.
1.   Heel spurs develop due to the constant pull of the short toe flexors & plantar fascia at the heel bone attachment.
2.    Full weight bearing activities compress the calcaneal (heel bone)
       nerves with resultant nerve trapping in the connective tissue.
3.   Normally there is a pad of fatty tissue under the heel bone. Both aging & weight gain flatten this shock absorber, compromising it’s ability to        absorb weight-bearing shock & subsequently causing heel pain.  
4    Calf muscle tightness results in compensatory patterns of weight bearing,      
      overstretching the fascia.  This may be structural or functional:
4.1    “structural” (“equinus”) or,
4.2    “functional” such as wearing high heels & then changing to flats
5.    Forefoot structure: reduced ankle range of motion with associated shortened fascia length results in excess tension on the plantar fascia
      5.1   eg.  “structurally” high arches (“pes cavus”) =
              shortened fascia
      5.2   eg.   “structurally” low arches (“pes planus”) =                  
              lengthened fascia
6.   During sleep the fascia begins to adhere to the heel.  
      The first  few A.M. foot-steps exacerbate pain due
       to stretching of the adhering tissue                               
7.   Training Habit Changes such as an increase in
       mileage & frequency of workouts or changes in
       exercise surface / terrain may injure the fascia.

Treatment Principles: Early treatment is advocated,
1.   Physician’s Examination: indications for medication
2.   P.R.I.C.E. Principals: Ice 4 times/ day & rest as directed by your       
          physiotherapist
3.    Activity Modification: reduce walking, running,  full weight bearing time,
       eliminate barefoot walking, avoid jarring to the heel & cross train (water
       run, swim, cycle, upper body training & core strengthening).                                                                                               
4.   Shock Absorb: use heel cushions in all shoe-ware  
5.   Foot Control: Mechanically control heel & longitudinal arch movement   
        with taping & if indicated progress to orthotics
6.   Shoe-ware: Always use supportive shoes, including in the morning
       before touching your foot to the ground.  Get new shoes before their   support & cushion functions are lost
7.    Weight:  Maintain the recommended healthy weight
8.    Physical Therapy: stretch the plantar fascia, strengthen the lower leg muscles to stabilize the ankle &      heel                                                                    
9.    Splint: use night splint  to maintain optimal fascia length

      
  Return to Sport / Activity?  This is directed by presence of pain & not time since pain began.  To safely return to activity, you must:
•     be pain free,
•     have full range of motion,  
•     have full strength of the injured foot.  
        &  you must be able to:
•     move straight ahead without pain or limping.
•     spring straight ahead without pain or limping.
•     do 45-degree cuts, both at half-speed & at full-speed.
•     do 10-yard figures-of-eight, both at half-speed & at full-speed.
•      jump on both feet without pain, together & separately.