Plantar fasciitis is inflammation of the fascia on the sole of the foot.

The Plantar fascia is a band of tissue that starts in the heel and runs forward to the toes.  It is one of three support structures of the arch of the foot, and plays a vital role in supporting the foot, as well as in toeing off correctly.

This fascia is connective tissue which forms membranous layers of varying thickness in all regions of the body. All fascia join into the next level, so the plantar fascia, joins (lightly) to the Achilles tendon, and so on. It is a dynamic structure that assists in support and movement in the whole body. Plantar fasciitis occurs when this layer in the sole of the foot becomes inflamed.

Prevalence


Although the epidemiology of this inflammation in the general population of Australia is currently uncertain, a 2010 North West Adelaide population-based study of 3 206 randomly selected respondents has reported a heel pain prevalence of 3.6 percent among respondents.

The department of Epidemiology and Preventative Medicine, in Melbourne, says plantar fasciitis is the most commonly reported cause of chronic pain beneath the heel.

It is reported to account for 10 percent of running injuries and is especially prevalent among military personnel. Incidence has also been shown to peak in people aged 40 to 60, and in young people among runners.

Causes


The cause is thought to be inflammation possibly due to excessive stretching (overuse, either sudden overload or a gradual increase in load) of the plantar fascia between the two areas of the foot to which it is attached. The actual inflammatory process is now being questioned and the current understanding is that it is a fasciopathy, which is different from true inflammation.

Plantar fasciitis, heel-spur pain, Inferior calcaneal bursitis and calcaneal enthesopathy (the enthesis is where the plantar fascia has its origin against the heel bone calcanues) are all similar conditions.

However these conditions must be differentiated from each other, despite their treatments being very similar

It may be associated with heel spurs, but this is not certain and the finding of a heel spur on X-ray may be purely coincidental, since many people have bony spurs with no problems with plantar fasciitis. A heel spur is a bony outgrowth from the weight-bearing part of the heel. The inflammation can be part of a wider condition such as rheumatoid arthritis.

Symptoms


The main problem is pain beneath the heel on standing or walking, most often felt after resting or on waking. The pain extends towards the inside of the foot and into the sole. This can be crippling in some people and makes walking almost impossible.

When the inflammation is part of something like rheumatoid arthritis, both feet can be affected. When the foot is examined, there is marked tenderness over the inner side of the foot and particularly over the weight-bearing part of the heel.

When flexing the big toe, a band of tissue can be felt running from the heel to the big toe, this is the plantar fascia and the pain can be anywhere from the heel to the toe. In some cases it can be felt just behind the lesser toes as well.

X-rays usually do not show any abnormality, although a heel spur may be seen in some people. The presence of a spur is often incidental and often not the cause of the pain

Treatment


The most important part of plantar fasciitis treatment is to educate the patient that, despite treatment, it can be a resistant condition and that resolution takes time. In fact, there are some people who believe that you never cure fasciitis, but you can only manage it to be pain free. Diagnosis may require a specialist examination, using ultrasound visualisation.

Treatment is divided into two parts:

    • First part is to treat the symptom with physiotherapy, rest, ice, electrical modalities like ultrasound, mobilisation, and stretching the fascia of the foot and calf. This can all help.

    • Second part is the use of shockwave therapy, cortisone injection (some pundits argue against this), non-steroidal anti-inflammatory drugs, night splints, crutches and walking boots.



The use of in-shoe biomechanically correct orthotic devices has been shown to assist in the healing and resolution of plantar fasciitis. Orthotics may achieve the following results:

    • Support the arch and decrease the stretch in the plantar fascia.

    • Correct the alignment of the heel which causes the arch to collapse.

    • Correct the toe-off mechanism which is an essential part of the function of the plantar fascia.

    • Raise the heel, which reduces the tension in the plantar fascia and Achilles tendon.

    • Cushions the heel.



If the fasciitis is part of a widespread inflammatory condition such as rheumatoid arthritis, then treating the arthritis will help the fasciitis.

When to see a doctor or podiatrist?


If you have pain in the sole of your foot, which is not getting better, then see your doctor, or podiatrist. The most common mistake patients make is thinking it will get better by itself.

The longer you have plantar fasciitis, the longer it takes to treat. If the symptoms are not resolving or completely healed in two to three weeks, get help as soon as possible.

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