PLANTAR FASCIITIS
A thick band of tissue at the bottom of the foot called the plantar fascia can become inflamed and cause plantar fasciitis/heel pain (spur) syndrome.
Around 10% to 15% of people might develop plantar fasciitis, a rather common foot condition. It can happen to anyone at any age. It is sometimes referred to as the "policeman's heel." The plantar fascia expands when subjected to excessive stress as a result of improper loading, leading to microtears and tissue degradation. It can cause discomfort in the arch area of the foot, the heel, and the entire bottom of the foot. Because scar tissue is less flexible than the fascia and cannot fully heal these micro tears, the condition may not be resolved for several months. Nonetheless, conservative treatment is effective in about 90% of instances.
CAUSES OF PLANTAR FASCIITIS
Most of the time, there is no known cause, and anyone can be impacted. It can affect both athletes and non-athletes, and it is most prevalent in persons over the age of 40.
Possible causes include:
- Faulty foot mechanics - Poor foot, knee, and/or hip mechanics (such as pronated (flat) feet, supinated (high arched) feet, or inward-pointing knees) result in an irregular gait pattern and have a negative impact on the distribution of weight on the foot.
- Stiff calf muscles and the Achilles tendon increase the strain on the plantar fascia by preventing the calcaneus (the heel bone) from moving freely.
- Unsuitable footwear- Shoes with thin soles, poor fitting, little arch support, and no shock absorption provide the foot insufficient protection (e.g. flip flop type shoes). High-heeled shoe usage on a regular basis shortens the Achilles tendon and strains the plantar fascia.
- Physical activity overload - progressing too quickly in a sport or exercise might overstress your foot. Professions that demand a lot of standing, especially on hard surfaces, or shifts lasting eight hours or longer, may also contribute.
- Weight- Carrying too much weight, especially suddenly increasing weight, causes extra strain on your foot.
- Other factors: Age, family history, and medical disorders including diabetes and arthritis may also be involved.
SYMPTOMS
- Pain frequently worsens when first bearing weight in the morning or after a rest.
- It typically develops gradually without any harm to the area.
- Although it occasionally appears sharp, the pain is mostly a deep, throbbing feeling. This may be located anywhere on the sole and heel's bottom. But, frequently, a single area is identified as the primary source of discomfort and may be painful to touch . This is frequently four cm in front of your heel.
- It frequently gets better with activity, but at the end of the day or after spending a lot of time standing, it may become more severe.
- Although it could take up to 18 months, the expectation is that the pain will go. It might just last a few weeks in a large number of individuals. The length of time it will last varies depending on the individual.
DIAGNOSIS
Physical Examination
The physical examination of individuals with heel pain should emphasis on identifying the pain's precise location, examining for heel cord tightness, and identifying any other possible causes of heel pain.
- The standing posture and gait are assessed at the onset of the physical examination. Although people with pes planus or pes cavus are predisposed to developing PF, special focus should be given to the alignment of the hindfoot and the midfoot.
- To detect tenderness, the plantar fascia and its origin at the calcaneus should be palpated.
- Both the knee flexed and extended should be used to measure the ankle's dorsiflexion range of motion. Gastrocnemius Equinus is indicated by less than 10 degrees of dorsiflexion with the knee extended or by more than a 10-degree difference between dorsiflexion with the knee flexed and extended (ie, a positive Silverskiold test).
- To rule out tarsal tunnel syndrome and calcaneal stress fracture, special tests should be performed, such as the Tinel test along the distal section of the tibial nerve.
- Plantar fasciitis is suggested by pain with passive dorsiflexion of the ankle and toes (windlass test).
IMAGING TEST
- The patient's medical history (symptoms) and physical examination are often used to make the diagnosis of plantar fasciitis.
- Simple x-rays are rarely necessary. Even so, a lateral, weight-bearing examination of the foot will frequently show a calcaneal heel spur when it is performed. The same traction phenomenon that overloads the plantar fascia and its origin essentially has the potential to result in excessive bone growth, such as a calcaneal heel spur.
- Nevertheless, symptoms are NOT always correlated with the existence of a heel spur. The majority of people with heel spurs on x-rays are asymptomatic, whereas the majority of patients with substantial plantar fasciitis do not show a heel spur on plain x-ray.
- Patients with heel discomfort that is thought to be secondary to plantar fasciitis are initially not suitable for MRI. A calcaneal stress fracture and other potential causes of heel pain may be ruled out with an MRI, though, if symptoms persist after professional treatment.
TREATMENT
Non-Operative Treatment
- Anti-Inflammatory Medication (NSAIDs) : NSAIDs can be used to help in pain management
- Activity Modification
- Over-the-counter Orthotics
- Plantar Fascia Night Splint
- Injection therapy
- Physical Therapy
Operative Treatment
Over a period of 3-6 months, 90% of patients will react to adequate non-operative therapy options. Patients with persistent symptoms can choose surgery as a treatment option, however it is NOT advised unless the patient has received unsuccessful non-operative management for at least 6 to 9 months.
Surgical intervention may include extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.
REHABILITATION
Understanding what stage of healing the condition is in and adjusting treatment to promote repair are essential for efficient plantar fasciitis therapy.
ACUTE PHASE
GOAL
- Decrease inflammation
- Promote tissue healing
- Retard muscular atrophy
Following are some effective therapy options for acute plantar fasciitis ;
REST
- Continuing weight bearing activities can tear and reinjure the fascia
- Doing various forms of exercise that don't severely aggravate their symptoms, like swimming, cycling, and aqua jogging, can assist maintain fitness (running in water).
- To avoid standing for extended periods of time, try to change the work schedule.
CRYOTHERAPY
- Remove the shoes and place the foot on a frozen water bottle.
- Below the foot's arch, roll the bottle back and forth.
- For five minutes, keep rolling.
- Do this 2 to 4 times daily.
GENTLE STRETCHING OF THE CALVES AND PLANTAR FASCIA
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| SOLEUS MUSCLE STRETCHING |
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| PLANTAR FASCIA STRETCHING |
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| GASTROCNEMIUS MUSCLE ANKLE STRENGTHNING |
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| ANKLE DORSIFLEXION |
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| ANKLE INVERSION |
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| CALF RAISES |
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| ANKLE EVERSION FOOT INTRINSIC STRENGTHNING  TOE SWAPPING   SCRUNCHING A TOWEL  OUT AND IN CROSS FRICTION RELEASE  ISOMETRICS  INVERSION   PLANTAR FLEXION  DORSIFLEXION SUBACUTE PHASE GOAL:
All the ACUTE PHASE Exercises are performed + PAIN FREE CLOSED KINETIC CHAIN HIP / KNEE STRENGTHNING   STEP UP LATERAL  WALL SQUATS  STANDING HEEL LEG RAISES- SIGNLE LEG  SIDE STEPPING  LATERAL LUNGE  POSTERIOR LUNGE  SINGLE LEG DEADLIFT  SINGLE LEG STANCE IR/ER CHRONIC PHASE GOALS:
All the ACUTE PHASE And SUBACUTE PHASE Exercises are performed Footwear should include a rocker-bottom shoe   SHOE MODIFICATION With conservative therapy and a self-limiting illness, symptoms typically go away within a year after the initial appearance. Sometimes, more severe and chronic cases of this problem require additional monitoring to assess the need for more advanced treatments and to assess the gait and biomechanical factors that may be able to be improved by gait retraining. Injections of corticosteroids have been demonstrated to be helpful in the short term (less than four weeks), but useless in the long term. |
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