General info
Summary

Data about the condition

Plantar fasciitis is the result of collagen degeneration of the plantar fascia at the origin, the calcaneal tuberosity of the heel as well as the surrounding perifascial structures.

  • The plantar fascia plays an important role in the normal biomechanics of the foot.
  • The fascia itself is important in providing support for the arch and providing shock absorption.
  • Despite the diagnosis containing the segment “itis,” this condition is notably characterized by an absence of inflammatory cells.

There are many different sources of pain in the plantar heel besides the plantar fascia and therefore the term “Plantar Heel Pain” serves best to include a broader perspective when discussing this and related pathology.

Symptoms

  • Heel pain with first steps in the morning or after long periods of non-weight bearing;
  • Tenderness to the anterior medial heel;
  • Limited dorsiflexion and tight achiles tendon;
  • A limp may be present or may have a preference to toe walking;
  • Pain is usually worse when barefoot on hard surfaces and with stair climbing;
  • Many patients may have had a sudden increase in their activity level prior to the onset of symptoms;

Causes

There are many risk factors which contribute to plantar heel pain including but not limited too: 

  • Loss of ankle dorsiflexion (talocrural joint, deep or superficial posterior compartment);
  • Pes cavus OR pes planus deformities;
  • Excessive foot pronation dynamically;
  • Impact/weight-bearing activities such as prolonged standing, running, etc;
  • Improper shoe fit;
  • Elevated BMI > kg/m2;
  • Diabetes Mellitus (and/or other metabolic condition);
  • Leg length discrepancy;
  • Tightness and/or weakness of Gastrocnemius, Soleus, Tendoachilles tendon and intrinsic muscle.

The objectives of the Recovery Program

When treating plantar fasciitis, the main objectives are to:

  • Relieve inflammation
  • Allow tears to heal
  • Correct any foot problems that may contribute to (such as over-pronation)
  • Relieve pain

The content of the Recovery Program

Strength Training.  Similar to tendinopathy management, high-load strength training appears to be effective in the treatment of plantar fasciitis. High-load strength training may aid in a quicker reduction in pain and improvements in function.

Achilles tendon stretching can be performed in a standing position with the affected leg placed behind the contralateral leg with the toes pointed forward. The front knee was then bent, keeping the back knee straight and heel on the ground. The back knee could then be in a flexed position for more of a soleus stretch.

Posterior-night splints maintain ankle dorsiflexion and toe extension, allowing for a constant stretch on the plantar fascia. Some evidence reports night splints to be beneficial but in a review by Cole et al he reported that there was limited evidence to support the use of night splints to treat patients with pain lasting longer than six months, and patients treated with a custom made night splints improved more than prefabricated night splints.

 Acetic acid iontophoresis combined with taping.Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device whether they are custom made or prefabricated. Level of evidence 1b . When used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

Methodical Indications

  • Patients need to be told that the symptoms may take weeks or even months to improve (depending on circumstances of injury).
  • To follow the advice given eg rest from aggravating activities initially, ice, stretch.
  • Be aware of the importance of a home exercise plan.

Did you know that?

  • Accounts for about 10% of runner-related injuries (Some literature shows prevalence rates among a population of runners to be as high as 22%)
  • Thought to occur in about 10% of the general population
  • 83% of these patients being active working adults between the ages of 25 and 65 years old
  • 11% to 15% of all foot symptoms requiring professional medical care
  • May present bilaterally in a third of the cases
  • The average plantar heel pain episode lasts longer than 6 months and it affects up to 10-15% of the population
  • Approximately 90% of cases are treated successfully with conservative care
  • Females present with the plantar heel slightly more commonly than males
  • In the US alone, there are estimates that this disorder generates up to 2 million patient visits per year, and account for 1% of all visits to orthopedic clinics
  • Plantar heel pain is the most common foot condition treated in physical therapy clinics and accounts for up to 40% of all patients being seen in podiatric clinics

You can also read about Hand joints, Carpal Tunnel Syndrome.

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  1. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–7.
  2. ↑Jump up to:2.0 1 2.2 2.3 2.4 2.5 Buchanan BK, Kushner D. Plantar fasciitis.Available from:https://www.ncbi.nlm.nih.gov/books/NBK431073/ (last accessed 22.6.2020)
  3. Carlson RE, Fleming LL, Hutton WC. The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot ankle Int / Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 2000;21(1):18–25.
  4. Stecco C, Corradin M, Macchi V, et al. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. J Anat. 2013;223(August):1–12. doi:10.1111/joa.12111.
  5. Gefen A, Megido-Ravid M, Itzchak Y. In vivo biomechanical behavior of the human heel pad during the stance phase of gait. J Biomech. 2001;34:1661–1665. doi:10.1016/S0021-9290(01)00143-9
  6. Tweed JL, Barnes MR, Allen MJ, Campbell J a. Biomechanical consequences of total plantar fasciotomy: a review of the literature. J Am Podiatr Med Assoc. 2009;99(5):422–30.
  7. Cheung JT-M, An K-N, Zhang M. Consequences of partial and total plantar fascia release: a finite element study. Foot ankle Int / Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 2006;27(2):125–32. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16487466.
  8. Crary JL, Hollis JM, Manoli A. The effect of plantar fascia release on strain in the spring and long plantar ligaments. Foot ankle Int / Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 2003;24(3):245–50

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