What is Plantar Fasciitis?
The plantar fascia is a thick fibrous aponeurosis that connects the bones (calcaneus) of the heel to the toes with the role of supporting and maintaining the arch of the foot through tension. The plantar fascia supports about 13-14% of the total load in each foot and is involved in the biomechanical process that allows normal walking to occur. During weight-bearing, the plantar fascia acts like a spring to conserve and dissipate energy and helps provide propulsion through the foot. Due to having such an intergral role in walking and running Plantar fasciitis (PF) is the most common cause of chronic pain at the heel in adults, making up 11–15% of all foot complaints affecting one in ten people in their lifetime. Plantar Fasciitis initally involves inflammation of the fascia but over time develops into what is known as a Fascopathy that is more chronic in nature.
The main symptom of plantar fasciitis is pain around your heel on the bottom of your foot and at the arch. It presents as an intermittent dull or aching pain, which may develop with time into a sharp persistent pain over a period of time. It is commonly felt with the first few steps of the day in the morning that eases after a few minutes of moving or after a period of resting. It may also be felt at the beginning of strenuous activity, such as sports but may ease after a few minutes. Once it progress then it normally does not ease as quickly and can be sore more constantly and give sharp pain.
What causes Plantar Fasciitis?
Causes of Plantar Fasciitis or Fasciopathy are from overloading the tissue. This can be due to many factors. Problems normally occur when the fascia is subjected to repeated periods of increased load or tension, such as increased running, walking or change of footwear. This repeated tension and stretching can lead to inflammation and pain, generally at the area of the inner heel where the fascia attaches to the heel bone, however it can also occur in the middle of the arch of the foot, or nearer the toes
There are many factors that can contribute but here are the most commonly seen.
Over-use. Simply put, but too much activity such running, walking or standing for a long time, especially if this has increased recently increase over a short period of time.
Obesity. The evidence demonstrates that obesity is present in up to 70% of patients with PF.
Ageing. It does appear that older athletes seem to suffer from PF more often than younger athletes.
Shoes. Footwear without support may also cause more load on the P Fascia.
Walking barefoot on hard surfaces if you are not accustomed to this.
What Treatments can I do? will I need Surgery?
Treatments of Plantar Fasciitis can ecompass many different modailites and interventions. Initally treatment is aimed at adjusting levels of activity, appropriate rest and anti-inflammatories may be used to help quickly settle down this to help prevent further irritation.
Physiotherapy should be a focal part of the treatment. This can involve treatment through manaual therapy, taping and rehabilitaiotn including strteching, Intrinsic muscle strength and other strength exercises. These are all undertaken to help reduce load and support the plantar fascia and increase your foot and lower limb support.
Ice - Applying Ice or using a bottle with ice inside can be used for massage that can help strech but also provide pain relief.
Heel pads/Orthotics- Heel Pads are simple over the counter soft inserts that fit into your shoe that can help reduce pain at the heel by helping absorb force. Orthotics can be bought over the ocunter to help offload and support the fascia but this is far better given by a podiatrist as they are experts in assessing and presribing bespoke Orthotics.
Extracorporeal Shockwave Therapy- Shockwave Therapy is an excellent option as this can help in reducing the symptoms and aid recover.
Approximately 90% of patients with PF can be successfully treated without surgery.
We would advise that you are seen in clinic for an assessment to determine your causative factors and the most suitable treatment. We can help guide you through your treatment and process to help you recover. If you require further assistance we can then direct you to the appropriate podiatrists or orthopedic consutlants if required.
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