18/07/2016
What is plantar fasciitis? http://www.physiotherapyequipments.com/
Plantar fasciitis means
inflammation of your plantar
fascia. Your plantar fascia is a
strong band of tissue (like a
ligament) that stretches from your
heel to your middle foot bones.
It supports the arch of your foot
and also acts as a shock-absorber
in your foot.
What causes plantar
fasciitis?
Repeated small injuries to the
fascia (with or without
inflammation) are thought to be
the cause of plantar fasciitis. The
injury is usually near to where
the plantar fascia attaches to
your heel bone.
You are more likely to injure your
plantar fascia in certain
situations. For example:
If you are on your feet for a lot
of the time, or if you do lots of
walking, running, standing, etc,
when you are not used to it.
(Plantar fasciitis may be confused
with 'Policeman's heel', but they
are different. Policeman's heel is
plantar calcaneal bursitis -
inflammation of the sack of fluid
(bursa) under the heel bone.
This is not as common as plantar
fasciitis.) Also, people with a
sedentary lifestyle are more prone
to plantar fasciitis.
If you have recently started
exercising on a different surface -
for example, running on the road
instead of a track.
If you have been wearing shoes
with poor cushioning or poor arch
support.
If you are overweight - this will
put extra strain on your heel.
If there is overuse or sudden
stretching of your sole. For
example: athletes who increase
running intensity or distance;
poor technique starting 'off the
blocks', etc.
If you have a tight Achilles
tendon (the big tendon at the
bottom of your calf muscles
above your heel). This can affect
your ability to flex your ankle
and make you more likely to
damage your plantar fascia.
Often there is no apparent cause
for plantar fasciitis, particularly in
older people. A common wrong
belief is that the pain is due to
a bony growth or 'spur' coming
from the heel bone (calcaneum).
Many people have a bony spur of
the heel bone but not everyone
with this gets plantar fasciitis.
How common is plantar
fasciitis?
Plantar fasciitis is common.
Around 1 in 10 people will get
plantar fasciitis at some time in
their life. It is most common in
people between the ages of 40 to
60 years. However, it can occur
at any age. It is twice as
common in women as it is in
men. It is also common in
athletes.
What are the symptoms
of plantar fasciitis?
Pain is the main symptom. This
can be anywhere on the
underside of your heel. However,
commonly, one spot is found as
the main source of pain. This is
often about 4 cm forward from
your heel, and may be tender to
touch.
The pain is often worst when
you take your first steps on
getting up in the morning, or
after long periods of rest where
no weight is placed on your foot.
Gentle exercise may ease things
a little as the day goes by, but
a long walk or being on your feet
for a long time often makes the
pain worse. Resting your foot
usually eases the pain.
Sudden stretching of the sole of
your foot may make the pain
worse - for example, walking up
stairs or on tiptoes. You may
limp because of pain. Some
people have plantar fasciitis in
both feet at the same time.
How is plantar fasciitis
diagnosed?
Your doctor can usually diagnose
plantar fasciitis just by talking to
you and examining your feet.
Rarely, tests are needed if the
diagnosis is uncertain or to rule
out other possible causes of heel
pain. These can include X-rays of
the heel or an ultrasound scan of
the fascia. An ultrasound scan
usually shows thickening and
swelling of the fascia in plantar
fasciitis.
What is the initial
treatment for plantar
fasciitis?
Usually, the pain will ease in
time. 'Fascia' tissue, like
'ligament' tissue, heals quite
slowly. It may take several
months or more to go. However,
the following treatments may
help to speed recovery. A
combination of different
treatments may help. Collectively,
these initial treatments are
known as 'conservative' treatments
for plantar fasciitis.
Rest your foot***
This should be done as much as
possible. Avoid running, excess
walking or standing, and undue
stretching of your sole. Gentle
walking and exercises described
below are fine.
Footwear***
Do not walk barefoot on hard
surfaces. Choose shoes with
cushioned heels and a good arch
support. A laced sports shoe
rather than an open sandal is
probably best. Avoid old or worn
shoes that may not give a good
cushion to your heel.
Heel pads and arch supports
You can buy various pads and
shoe inserts to cushion the heel
and support the arch of your
foot. These work best if you put
them in your shoes at all times.
The aim is to raise your heel by
about 1 cm. If your heel is
tender, cut a small hole in the
heel pad at the site of the
tender spot. This means that the
tender part of your heel will not
touch anything inside your shoe.
Place the inserts/pads in both
shoes, even if you only have pain
in one foot.
Pain relief***
Painkillers such as paracetamol
will often ease the pain.
Sometimes anti-inflammatory
medicines such as ibuprofen are
useful. These are painkillers but
also reduce inflammation and
may work better than ordinary
painkillers. Some people find that
rubbing a cream or gel that
contains an anti-inflammatory
medicine on to their heel is
helpful.
An ice pack (such as a bag of
frozen peas wrapped in a tea
towel) held to your foot for 15-20
minutes may also help to relieve
pain.
PHYSIOTHERAPY***
Regular, gentle stretching of your
Achilles tendon and plantar fascia
may help to ease your symptoms.
This is because most people with
plantar fasciitis have a slight
tightness of their Achilles tendon.
If this is the case, it tends to
pull at the back of your heel and
has a knock-on effect of keeping
your plantar fascia tight. Also,
when you are asleep overnight,
your plantar fascia tends to
tighten up (which is why it is
usually most painful first thing
in the morning). The aim of
these exercises is to loosen up
the tendons and fascia gently
above and below your heel. Your
doctor may refer you to a
physiotherapist for exercise
guidance.
The following exercises, done
either with or without shoes on,
can be used to help treat
plantar fasciitis:
Stand about 40 cm away from
a wall and put both hands
on the wall at shoulder
height, feet slightly apart,
with one foot in front of the
other. Bend your front knee
but keep your back knee
straight and lean in towards
the wall to stretch. You
should feel your calf muscle
tighten. Keep this position
for several seconds, then
relax. Do this about 10 times
then switch to the other leg.
Now repeat the same
exercise for both legs but
this time, bring your back
foot forward slightly so that
your back knee is also
slightly bent. Lean against
the wall as before, keep the
position, relax and then
repeat 10 times before
switching to the other leg.
Repeat this routine twice a
day.
Stand on the bottom step of
some stairs with your legs
slightly apart and with your
heels just off the end of the
step. Hold the stair rails for
support. Lower your heels,
keeping your knees straight.
Again you should feel the
stretch in your calves. Keep
the position for 20-60
seconds, then relax. Repeat
six times. Try to do this
exercise twice a day.
Sit on the floor with your
legs out in front of you. Loop
a towel around the ball of
one of your feet. With your
knee straight, pull your toes
towards your nose. Hold the
position for 30 seconds and
repeat three times. Repeat
the same exercise for the
other foot. Try to do this
once a day.
Sit on a chair with your
knees bent at right angles
and your feet and heels flat
on the floor. Lift your foot
upwards, keeping your heel
on the floor. Hold the
position for a few seconds
and then relax. Repeat about
10 times. Try to do this
exercise five to six times a
day.
For this exercise you need an
object such as a rolling pin
or a drinks can. Whilst
sitting in a chair, put the
object under the arch of your
foot. Roll the arch of your
foot over the object in
different directions. Perform
this exercise for a few
minutes for each foot at least
twice a day. This exercise is
best done without shoes on.
Are there any other
treatments?
If the above treatments are not
helping to relieve your symptoms,
or if you are someone such as
an athlete who needs a quick
recovery, other treatments are
available. There is no one
specific treatment that appears to
stand out as the best.
Steroid injections
A steroid (cortisone) injection is
sometimes tried if your pain
remains bad despite the above
'conservative' measures. It may
relieve the pain in some people
for several weeks but does not
always cure the problem. It is
not always successful and may be
sore to have done. Steroids work
by reducing inflammation.
Sometimes two or three injections
are tried over a period of weeks
if the first is not successful.
Steroid injections do carry some
risks, including (rarely) tearing
(rupture) of the plantar fascia.
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.
This procedure appears to be
safe but it is uncertain how well
it works. This is mostly because
of a lack of large, well-designed
clinical trials. You should have a
full discussion with your doctor
about the potential benefits and
risks.
In studies, most people who have
had extracorporeal shock-wave
therapy have little in the way of
problems. However, possible
problems that can occur include
pain during treatment, skin
reddening, and swelling of your
foot or bruising. Another
theoretical problem could include
the condition getting worse
because of rupture of your
plantar fascia or damage to the
tissues in your foot. More
research into extracorporeal
shock-wave therapy for plantar
fasciitis is needed.
Other treatments***
Various studies and trials have
been carried out looking at other
possible treatments for plantar
fasciitis. Such treatments include
injection with botulinum toxin
and treatment of the plantar
fascia with radiotherapy. These
treatments may not be widely
available.
Some people benefit from
wearing a special splint overnight
to keep their Achilles tendon and
plantar fascia slightly stretched.
The aim is to prevent the plantar
fascia from tightening up
overnight. In very difficult cases,
sometimes a plaster cast or a
removable walking brace is put
on the lower leg. This provides
rest, protection, cushioning and
slight stretching of the plantar
fascia and Achilles tendon.
However, the evidence for the
use of splint treatment of plantar
fasciitis is limited.
Surgery***
This may be considered in very
difficult cases. Surgery is usually
only advised if your pain has not
eased after 12 months despite
other treatments. The operation
involves separating your plantar
fascia from where it connects to
the bone; this is called a plantar
fascia release. It may also involve
removal of a spur on the
calcaneum if one is present.
Surgery is not always successful.
It can cause complications in
some people so it should be
considered as a last resort.
Complications may include
infection, increased pain, injury
to nearby nerves, or rupture of
the plantar fascia.
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