Description

The plantar fascia is a thick, strong, ligamentous band attached from heel bone to the five metatarsal bones and running underneath the skin on the plantar (bottom) surface of the foot along the arch. It supports the medial longitudinal arch, helps prevent overpronation and acts like a windlass (an apparatus for moving heavy weights) so the foot can push off with the toes dorsiflexed. Plantar fasciitis occurs when stress (excess torquing) on the fascia causes it to pull the lining of the bone away from the bone at the fascia’s insertion into the heel bone. It is the most common cause of heel pain and can be caused by mechanical factors of the feet (Pes Planus, Pes Cavus, tight Achilles tendon or calf muscles), overloading due to obesity, overuse, improper/old footwear, standing/walking for long periods on hard surfaces, especially when barefoot.

Symptoms

Pain (severe, burning, breath taking) on the plantar aspect of the foot under the heel bone and in the medial arch sometimes with point tenderness at the fascial insertion is the most common complaint. This pain is worse in the morning or after rest and may increase with activities. As gait and biomechanics are altered to avoid weight bearing on the affected heel, pain and stiffness can appear in the ankles, knees, hips and low back.

Pedorthic Management

• Custom made orthotics – Help to provide proper support and alignment to the foot, controlling over pronation, thereby reducing stress on the plantar fascia. Over the counter orthotics may also be useful depending on foot shape and the amount of abnormal mechanical forces assessed.
• Heel lifts raise the heel reducing pressure on the plantar fascia insertion point. The lift may be applied to both orthotics or shoes (under the insole).
• Orthopedic footwear – properly fitted (including the footwear to be worn around the house), strong, structured and stable with good shock absorption and good heel height to reduce strain on the plantar fascia.
• Night splints (Strassburg Sock)

Other Treatments/Modalities

• R(rest) I(ice) C(compression) E(elevation)
• Stretching and strengthening exercises
• Strapping
• Light and sound wave therapies
• Cortisone injections
• Anti-inflammatory medication
• Weight loss
• Surgery in severe cases