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Planter Fasciitist

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What is a Plantar-fasciitis? One of the most common causes of heel pain.

Plantar-fasciitis is a condition sometimes also called heel pain and “policeman’s heel” among other titles.
It is a sharp, intense pain felt in the foot, usually just in front in front of the heel but sometimes in the heel as well and usually occurs first thing after getting out of bed or when the patient has been sitting still for a period such as watching tv in the evening.

It is caused by constant stretching of a long band of cartilage called the plantar fascia, which holds the structure of the foot together.

There can be a number of causes, such as obesity, long periods of overuse (such as jobs that involve standing and walking for most of the day) or tight leg muscles.
It is the strain exerted on the cartilage which cause the fibres of the plantar fascia to break, leading to inflammation and pain after a period of rest.
It most commonly seen in women aged around 40-60, but almost anyone can develop it.

It usually improves after a few steps have been taken, but the period of pain can be extremely uncomfortable.

The good news is that it can be easily treated and will usually get better, but the cause needs to be investigated.
Sometimes (but by no means always) orthotic insoles may be required to help the foot to function better and relieve the stress on the plantar fascia. Sometimes exercises to reduce muscle tension may be all that is needed.

Definition: ‘Acute or chronic inflammation of plantar fascia due to formation of microtears in response to repetitive exercise tensile forces (eg. As in overpronation or cavoid foot type); characterised by pain, acute or chronic discomfort in proximal, central or distal part of the plantar fascia, that may radiate into the Achilles tendon’ (Mooney, 2009)128).

Clinical Features: The patient may experience severe pain when taking their first steps in the morning after sleeping, at the beginning of activity and when standing for a long time. Patients with the condition can also experience stiffness in the heel area and those with a severe case may experience the pain in heel increasing throughout the day (Young et al, 2001). The condition may occur in one of both feet and the pain can be felt as distally as the metatarsophalangeal joint. The most common cause of plantar fasciitis is an overly tight calf muscle which leads to persistent pronation of the foot, which produces over-stretching of the arch tendon, and can lead to inflammation and thickening of the tendon. Patient presented to the clinic with pain in the heel, especially in the morning. Inflammation of the plantar aponeurosis at the insertion into the calcaneus (Mooney and Campell, 2010).

Cause: Plantar Fasciitis is caused due to the degeneration of collagen within the plantar aponeurosis at the point of insertion, which is the medial tubercle of the calcaneus. Degeneration is through excess stresses placed on the plantar aponeurosis resulting in micro tears to the structure. There is an increase in the condition amongst people with pes planus and pes cavus, mainly seen in those that run and within people who possess tightness within their superficial calf muscles and intrinsic foot muscles (Young et al, 2001). Plantar Fasciitis rates are increased in people with obesity problems and those that stand for long periods of time (Mooney and Campell, 2010).

Management: The treatment of Plantar Fasciitis can take from 6 to 18 months and requires the patient to undertake several different therapies (Mooney, 2009). 

Rest: The optimum treatment for the patient is complete rest, this however is unlikely to be achieved in most patients. Athletes are therefore advised to undertake change in the type of activities undertaken. 

Exercises: Patients can be provided with a number of stretching and strengthening exercises. Examples of these exercises are walk stretches and stair stretches which are partially useful for those with tight calf muscles (gastrocnemius and soleus). Simple items for example a tin can or tennis ball can be used to undertake dynamic stretches. Towel curls and toe taps can be used for the intrinsic muscles of the foot (Mooney and Campbell, 2010). 

References: Mooney, J (2009) Illustrated dictionary of Podiatry and Foot Science, Churchill Livingstone Elsevier, London. Mooney, J. and Campell, R. (2010) Adult foot disorders. In Frowen, P. O’Donnell, M. Lorimer, D. and Burrow, G. Neale’s Disorders of the Foot. 8th edition. Edinburgh: Churchill Livingstone p. 127

Talar made (2016) ‘Quadrastep foot orthoses’. [On line] Available at: http://www.talarmade.com/products/1085-quadrastep-foot-orthoses-model-f.aspx (accessed 15/11/’15

WEBMD (2015) ‘Plantar fasciitis: Symptoms, diagnosis and treatment’ [On line] Available at: http://www.webmd.boots.com/foot-care/plantar-fasciitis-symptoms-diagnosis-treatment (Accessed 10/11’15). Young, C.C., Rutherford, D.S., and Niedfeldt, M.W. (2001) Treatment of plantar fasciitis. American Family Physician, Vol 63(3).p. 467-474.