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Plantar Fasciitis

Definition

Plantar Fasciitis, or Plantar Fasciosis, is an inflammation caused by excessive stretching of the plantar fascia. The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, attaching at the bottom of the heel bone and extending to the ball of the foot (forefoot). When the plantar fascia is excessively stretched, this can cause plantar fasciitis, which can also lead to heel pain, arch pain, and heel spurs.

 

Cause

A common misconception is that Plantar Fasciitis is caused by a heel spur and that plantar fasciitis is always accompanied by a spur. This is not entirely true, in fact plantar fasciitis can occur on its own without the presence of spur while the main cause of plantar fasciitis is over-pronation (flat feet).

On the other hand, Plantar Fasciitis itself can be a cause of a heel spur, heel pain and/or arch pain. The excessive stretching of the plantar fascia that leads to the inflammation and discomfort can be caused by the following: Over-pronation (flat feet) which results in the arch collapsing upon weight bearing A foot with an unusually high arch and a sudden increase in physical activity, Excessive weight on the foot, usually attributed to obesity or pregnancy, Improperly fitting footwear.

Over-pronation, the leading cause of plantar fasciitis occurs in the walking process (gait), when a person's arch collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone. With Plantar Fasciitis, the bottom of your foot usually hurts near the inside of the foot where the heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. As the day progresses and the plantar fascia continues to be stretched, the pain often subsides.

As the plantar fascia degenerates (particularly when this is not treated early on), degeneration of the plantar fascia can occur resulting in what is termed as plantar fasciosis. In plantar fasciosis the pain generally does not subside after the morning with the patient experiencing chronic pain. At this stage a degree of degeneration within the plantar fascia has occurred which may lead to irreversible damage. 

 

Treatment and Prevention

A Podiatrist will initially identify the cause of the excessive overuse of the plantar fascia, which is the key when devising a treatment plan. When the cause is over-pronation (flat feet), an orthotic with anti-pronatory device support is an effective device to reduce the over-pronation and allow the condition to heal. If you have high arches, which can also lead to plantar fasciitis, heel cushioning, shock absorption and use of sensible footwear that will accommodate and comfort the foot is often advised. Other common treatments include stretching exercises, plantar fasciitis night splints, wearing shoes that have a cushioned heel to absorb shock, and elevating the heel with the use of a heel cradle or heel cup. Heel cradles and heel cups provide extra comfort, cushion the heel, and reduce the amount of shock and shear forces placed during everyday activities.

You can reduce the strain and stress on the plantar fascia by following these simple instructions: Avoid running on hard or uneven ground, lose any excess weight, and wear shoes and orthotics that support your arch to prevent over-stretching of the plantar fascia.

It is strongly advisable that corticosteroid injections for plantar fasciitis are only used when the above modalities have been exhausted since research has shown that injection therapy can cause spontaneous rupture of the plantar fascia and such a treatment is only limited to three applications in the same location.

 

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