PLANTAR FASCIA PAIN
The plantar fascia is a very strong tissue that is designed to support the arch of your foot, and according to the research takes on approximately 14% of the total foot load. It originates from the underside of your heel bone and attaches to each of your five toes. It involves three main components – inside, central and outside. When walking, your plantar fascia is continuously elongating and shortening throughout the contact phase of your gait, and when toeing-off at the end stage of your gait, your plantar fascia becomes tense, resulting in elevation of your arch and shortening of the foot. In the younger years of your life, your plantar fascia and your Achilles is often connected via a fascia, however this continuity decreases with age as the fibres tear and wear away. Being a fascia, blood flow to the region is limited, which often results in slow healing time and recurrent injuries to the area are not uncommon. Rehabilitation after any injury is extremely important, and your health professional can discuss this in-depth with you throughout your treatment. ‘Plantar fasciitis’ covers several injuries to the plantar fascia. The 4 main categories of injury to the region are: 1. Plantar Fasciopathy 2. Heel Spurring 3. Plantar Fibromatosis 4. Plantar Fascia Tear/Rupture Plantar Fasciopathy Plantar Fasciopathy (often called plantar fasciitis) is the most common injury to the area, and generally, is easily treatable. Plantar Fasciopathy arises from increased inflammation over the tissue, and is a result of overstretching, overuse and/or certain medical conditions. Causative factors include a sudden increase in exercise/work levels, an increase in weight, pregnancy, change in footwear, high impact sport and your foot structure. If you have particularly high arches, this results in a lack of shock absorption and as a result your plantar fascia over time becomes inflamed and tight. With flat footedness, your plantar fascia becomes stretched out and pulls at the site of its attachment in its heel. As mentioned before, your plantar fascia and your Achilles are often connected with a band of connective tissue. Tight calf muscles can cause increased strain on the plantar fascia, and often calf stretching is recommended for the initial stages of pain. Pain is often felt in the first few steps after waking up, after a period of rest or after an extended period of exercise, and is usually described as an aching, pulling pain under the arch and heel. Plantar Fasciopathy is best treated with massage, strapping, stretching and lifestyle modifications, including footwear changes and potentially orthotics to help with poor foot function. Ice is usually recommended in the first week of injury to deal with inflammation, before using a combination of heat and ice. Other treatment modalities include Shockwave Therapy and Platelet Rich Plasma Injections (minimal research for both) and cortisone injections for relief; however cortisone is also shown to weaken soft tissue structures and can potentially cause long-term damage to the area. Calcaneal Spurring Your calcaneus is your heel bone, to which many structures attach and/or originate from. A calcaneus spur occurs at the two sites of the calcaneus. A posterior calcaneal spur occurs at the back of your heel, and often results in Achilles pain, whilst a plantar heel spur results under your heel. Both are bony outgrowths from the site of attachment of your Achilles and plantar fascia. Increased stress and strain to the foot results in calcium deposits occurring, causing spurring of the bone. These can be sitting in your foot for many years, before finally causing pain and injury to the area, and this generally results from Plantar Fasciopathy. The general belief is that heel spurs cause Plantar Fasciopathy, but this is in fact wrong. The plantar fascia, through factors discussed above, starts to tear at the site of its attachment, and this then causes the heel spur to become painful. The best treatment for heel spurring is to treat the underlying plantar fascia pain, and to protect the area for the first few weeks with padding and gel cushioning. As the plantar fascia loosens, the heel spur pain will generally cease. Custom orthotics again are a good long-term treatment for heel spurring, as your podiatrist can incorporate a variety of cushioned materials to help offload pressure from the spur. Plantar Fibromatosis Plantar Fibromatosis, or Ledderhose’s Disease, is a non-malignant thickening of the plantar fascia at certain sites. It often occurs in the inside/central portions of the plantar fascia, and the nodules are often slow-growing initially. Non-tender lumps are felt through the arch, but as the fibroma enlarges, it can cause tension and pain within the plantar fascia. Long-term treatment for Plantar Fibromas include release of the plantar fascia, ShockWave Therapy and/or surgery to remove the fibroma structures. Plantar Fascia Rupture/Tear As discussed previously, the plantar fascia is an extremely strong tissue under your foot. Often, with high impact exercise, increased weight, improper footwear and poor foot biomechanics, the plantar fascia tightens to the point where it starts to tear at certain aspects. Tearing of the plantar fascia doesn’t change much from the general treatment for Plantar Fasciopathy, however it does involve a longer rehabilitation period and increased strengthening exercises. Plantar Fascia Rupture is often described as a ‘popping’ sensation, with intense pain, swelling and bruising throughout the region. Patients generally are unable to push off with the foot, and walking becomes extremely difficult as a result. For Plantar Fascia Rupture, rest, ice, compression and elevation is the most important initial treatment. From there, your podiatrist may place you in a walking boot to offload tension from the plantar fascia and allow correct healing. Surgery is not recommended for rupture of the plantar fascia. Recovery time sits between 3-4 months, and involves an intensive rehabilitation period to allow the plantar fascia to repair. Footwear changes and orthotics are highly recommended for plantar fascia rupture, along with soft tissue release of calf muscles. STRETCHES Calves: Towel Stretch:Wrap towel around the ball of your foot, and pull back gently, ensuring your knee and leg is kept straight. You should feel a gentle stretch in the top of your calf muscle. Hold for 30 seconds, 3 times in the morning and evening Plantar Fascia: Tennis Ball Stretch: Whilst sitting on the edge of a chair/bed, roll your foot over a tennis ball/golf ball/spikey ball. Roll for 3-4 minutes morning and evening. Wall Stretch: Facing a wall, pop your toes against the wall, heel on the ground, and lean forward slightly. You should feel a gentle pulling in the arch and heel of your foot. Hold 30 seconds, 3 times in the morning and evening OTHER o Ice for 10 minutes in the evening o Heat for 10 minutes in the evening o Anti-inflammatories – Topical – Oral o Massage SUMMARY Heel pain in general can be caused by a variety of factors. The most common cause is the plantar fascia, and can lead to long-term debilitating pain and injuries. If you suffer from heel pain, do not attempt to ignore the pain and visit a podiatrist immediately for assessment and care. As the Plantar Fasciopathy turns from an acute to chronic pain, treatment becomes harder and the recovery time can often double. As mentioned before, recurrent episodes of heel pain can occur, and this can lead to long-term tearing of the plantar fascia.