By Amir Saipoor, BSc in Podiatric Medicine, PGDip Podiatric Surgery
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Specialist Podiatrist, Mr. Amir Saipoor, provides a fascinating and lucid overview of the causes, current diagnostic methods and common treatments for Plantar Fasciitis.
Plantar Fasciitis is one of the most common causes of heel pain (McPoil et al, 2008). It involves inflammation of a thick fibrous band, that runs across the bottom of your foot connecting your heel bone to your toes. Plantar fasciitis commonly causes stabbing pain, especially with the first steps in the morning, and as a patient walks more the pain reduces to some extent.
The origin of the plantar fascia is located at the heel and inserts into the base of the toes. It is a thick fibrous sheet that divides into 5 sections distally and extends to the phalanxes, overlapping the flexor tendons. It forms part of the stabilizing structures for the arch, aids in shock absorption and is an important factor in gait and dynamic activity (Hicks, 1954).
The exact cause of plantar fasciitis is poorly understood. However, it is considered that plantar fasciitis is a result of faulty biomechanics, attributed to excessive (over) pronation (Kwong et al, 1988). This suggests that increased amounts of stress to the plantar fascia results in stretching and overloading (Bolgla and Malone, 2004). Over a period, the repetitive stress can cause micro-trauma and micro-tears in the fascia, resulting in an inflammatory response and pain (Puttaswamiah and Chandran, 2007). Other factors described in the literature are Obesity / Overweight, Change in Activity, Pregnancy, Flat feet, High Arches, Inflammatory Arthritis & wearing shoes with poor support (McPoil et al, 2008).
Diagnosis of plantar fasciitis is usually deduced through patient history, however sometimes the specialist in care may request an X-ray, ultrasound or MRI to investigate further. Other diagnoses such as Heel bone bruising (Contusion), Baxter’s nerve entrapment, or calcaneal bursitis may need to be excluded.
Several treatments are available for plantar fasciitis, however the immediate standard treatment as for any soft tissue injury is R.I.C.E, which stands for:
– R: rest
– I: Ice
– C: Compression
– E: Elevation
This aims to allow rest from pain-provoking activity, as well as reduce pain and/or any swelling by applying ice 2-3 times daily for 5-10 minutes. In addition to this, patients can take anti-inflammatory medication (if tolerated). Changing footwear to more supportive trainers or shoes should be considered, as flat shoes may allow more abnormal movement than a supportive shoe. In some instances insoles may be required to support the foot and reduce the stress upon the plantar fascia. Other treatment options include steroid injections to reduce the inflammation locally and shockwave therapy. However, both are utilized if noninvasive treatments fail.