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Plantar Fasciitis

26th June, 2012

plantarfasciitisPlantar Fasciitis is the inflammation of your plantar fascia. The Plantar Fascia is a strong band of tissue (like a ligament) that stretches from the heel to the base of the toes. It supports the arch of your foot and also acts as a shock-absorber. Plantar Fasciitis most commonly affects active men between 40-70 years of age and about 70% of patients with Plantar Fasciitis have been noted to have a heel spur that can be seen on x-ray. It has also been noted that heel spurs can be seen on x-ray examination of many patients with no history of Plantar Fasciitis.

Generally this condition presents as a sharp heel pain that radiates along the bottom of the inside of the foot. The pain is often felt more when getting out of bed in the morning and most patients note a decrease in the ability to pull their toes up towards them. The pain may develop slowly over time, or suddenly after intense activity.

Several risk factors have been identified in the development of Plantar Fasciitis and these include:

  • Foot arch problems, both high arches or flattened
  • Sudden weight gain
  • Tight achilles tendon
  • Shoes with poor arch support or soft soles
  • Long distance running, especially on uneven surfaces or running downhill
  • Occupations that require prolonged weight-bearing

New reserarch has shown that high load strenthening exercises guided by a health profressional significantly improves foot function after three months compared with just stretching. Both group were advised to use insoles to ease symptoms. Ice application may also help, particularly when gently massaging the foot by rolling the affected foot over a bottle of iced water (see ice versus heat blog).

Treatment from a Chiropractor, Osteopath or Physiotherapist aims to reduce down the tension of the tissues, strengthen the foot support musculature and support any underlying biomechanical predispositions. A podiatry assessment may also be helpful in assessing the need for orthotics. Most experts agree that early recognition and treatment of Plantar Fasciitis leads to a shorter course of treatment and greater probability of success with conservative therapies.

Nonsurgical treatments almost always improve the pain. Ninety-five percent of patients respond to conservative care. The pain can however sometimes last from several months to 2 years before symptoms resolve. Most patients feel better in 9 months.To avoid developing Plantar Fasciitis, ensure that your ankle, achilles tendon and calf muscles are flexible.

Injections for plantar fasciitis
A steroid (cortisone) injection is sometimes tried if your pain remains bad despite the above 'conservative' measures. It can have a significant effect especially if all of the other measures are tried first, particularly the fitting of orthoses to reduce the tension on the plantar fascia. Steroids work by reducing inflammation.

An injection of 'Autologous Blood' ( your own blood taken from a vein in your arm) has been shown to be effective by promoting a healing response.

Sometimes the blood can be centrifuged and the 'platelet rich' part of the plasma (platelet rich plasma / PRP / autologous conditioned plasma) can be injected to encourage a more constructive healing process.

Extracorporeal shock-wave therapy
In extracorporeal shock-wave therapy, a machine is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works, but it is thought that it might stimulate healing of your plantar fascia. One or more sessions of treatment may be needed.

Surgery
This may be only be considered in very difficult cases. 

Contributing Authors:
Shelley Doole DC MChiro
Dr Simon Petrides
Alex Huntly, Physiotherapist

References

Baxter DE. The heel in sport. Clinical Sports Medicine, 1994; 13:685-693.
Buchbindcr R. Clinical practice. Plantar fasciitis. N Fngl J Med 2004:35O:2159-2166.
Gill LH. "Plantar Fasciitis: Diagnosis and Conservative Management" J. Am. Acad. Ortho. Surg., Mar 1997; 5: 109 - 117.
Rathleff MS, High load strength training improves outcome in patients with plantar fasciitis: A randomised control trial with 12 month follow up Scandinavian journal of medicineand sicene in sport. Aug 2014
Riddle, DL, et al. "Risk Factors for Plantar Fasciitis" J. Bone Joint Surg. Am., May 2003; 85: 872 - 877.
Young CC, Rutherford DS. Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician 2001:63:467-474.477-478. Erratum in: Am Fam Physician 2001;64:570