Plantar Fasciitis

The most misunderstood foot ailment in history.

Symptoms:

Common symptoms for patients are:

  • Pain first thing in the morning
  • Aching, throbbing and burning by the end of the day
  • Pain on immediate weight bearing after periods of sitting or lying down
  • Moderate to severe pain after sport or exercise

Anatomy:

Plantar Fasciitis is the pulling and micro tearing of the ligament like structure under the foot called the plantar fascia. Commonly near the insertion point at the heel, it can also occur in the mid fibres under the arch of the foot. As the fascia becomes more inflamed it can radiate around the back and side of the heel.

 

Bony spurs (heels spurs) can develop as nature’s way of trying to repair itself but are rarely associated with the pain itself.

Plantar Fasciitis

Cause:

The cause of Plantar Fasciitis varies from patient to patient. Age, weight, long periods of time on feet, excessive forefoot sports or activity and starting exercise after years of inactivity, appear to be the most common reasons.

 

Under normal conditions the structure of the foot supports body weight, but when that structure is no longer supportive due to any of the aforementioned reasons, the plantar fascial ligament takes excessive load. After time, (perhaps years) the fascia tears near attachment point of the heel causing acute pain.

 

What is often not understood is that normal daily routine (standing, walking etc.) overloads the fascia. Standing for long periods, sport, exercise – aggravate the injury and prevent the natural healing processes.

The 3 Phases of Plantar Fasciitis:

Plantar Fasciitis

1. First 3 -4 weeks

 

  • Dull pain usually in one foot ‘feels like a stone bruise’
  • Pain first thing in the morning, immediately on weight bearing
  • Begin walking on toes to avoid pain
  • With continued daily routine, activity, sport, work etc., pain intensifies

Traditional treatment: Simple calf muscle stretching, ice, good supportive footwear and rest, anti inflammatories, heel cushions, physiotherapy, acupuncture, arch supports, massage, heat, orthotics, rolling the foot over cans/bottles/golf balls etc. and cortisone.

 

At the end of this time most patients have ceased or greatly reduced their activity levels. Pain can continue to intensify which leads to the Phase 2.

 

2. 6 – 12 months

 

  • Intense pain for most of the day
  • Still usually consistent in one foot

Traditional treatment: By now most patients have tried a vast array of treatments including multiple cortisone injections.

 

At this stage patients have usually stopped all exercise, sport and sometimes work. This has obvious physical and psychological repercussions resulting in depression and negativity. In desperation, patients will try any number of solutions and well meaning advice. In some instances surgery can be suggested as a final solution.

 

3. Plantar fasciitis pain develops in “good foot” due to compensated body load (limping)

 

  • The body will adjust to constant pain by changing weight bearing forces leading to secondary pain in knees, hips and lower back due to incorrect foot alignment and posture
  • Increase in body weight from lack of exercise leading to an additional load on the plantar fascia during weight bearing
  • Pain can be acute and timeframes of up to 5 years are common
  • With incorrect or no treatment a return to normal lifestyle and activities will be associated with a return in pain due to patient’s foot type and biomechanics.

Plantar Fasciitis can potentially be a lifetime ailment.

Modern Day Ailment

The Clinic sees Plantar Fasciitis as a modern ailment brought about by the changes in lifestyle over the last 50-60 years. Daily surfaces are much harder, the workplace, home, shopping centres, footpaths, hospitals, schools and even some sporting venues, are concrete. To accommodate, footwear is generally softer with increased cushioning, lacking support and stability. Add to this the fact that we now live longer, are heavier and perform more intermittent activity. The foot structure cannot evolve quickly enough, hence Plantar Fasciitis is just one manifestation of these changes.

Plantar Fasciitis

Treatment:

The Heel Clinic treatment is to assess the functional movement (biomechanics) of the feet in the transition from heel strike to propulsion.

 

If the base cause appears on assessment to be functional, then the Clinic uses an advanced form of Insert to support and stabilise the heel. The Clinic has found that a heel base support instead of arch base control has more control and therefore success in treating the ailment.