Pronounced

PLAN-tar-fashee-EYE-tis

The Plantar Fascia encapsulates the muscles in the bottom of the foot, supports the arch by acting like a bow string connecting the heel bone to the ball of the foot.  Plantar Fasciitis condition is essentially inflammation of this connective tissue.

Defined

Sharp pain, stiffness and aching is very common with the ailment.  The origin of the plantar fascia experiences inflammation due to over-stretching of the fascia leading to excess traction and inflammation.  Scar tissue develops making the fascia less flexible.  This in turn causes further traction in other parts of the foot.

Symptoms

The patient presents with a dull to sharp pain occurring about the plantar calcaneal area when getting out of bed of a morning.  The plantar fascia is more inflexible at those times or when arising from a seated position and continuing during the initial periods of weight bearing.  Usually the pain subsides within a few minutes, but may re-occur once this sequence is re-established.  Many patients report that the pain 'moves around' to different areas of the foot.

Surveys in the USA show that overweight patients and/or those leading a sedentary lifestyle have a much higher incidence of heel pain, in fact recent reports indicate that over 2.5 million new cases are reported each year in the USA.

Biomechanical Aetiology

Plantar Fasciitis is generally the result of faulty biomechanics - walking gait abnormalities that place too much stress on the heel bone and the soft tissues attached to it.

Excess subtalar joint pronation lowers the arch structure and as the foot elongates, a traction force is placed on the plantar fascia.  These tractional forces can result, over time, in inflammation of the fascia and surrounding tissues, thus causing pain in the arch and heel.  If chronic traction of the plantar fascia from the calcaneal tuberosity occurs, then this may lead to the development of a bony growth on the calcaneal tuberosity.  The resultant projection or bone growth may be called a 'spur' - referred to as a 'heel spur'.  Plantar fasciitis is the forerunner to a heel spur.

Restriction of dorsiflexion of the foot through the presence of tight calf muscles can often add to plantar fascial pain due to restriction in dorsiflexion of the foot during the propulsive phase of gait.  When these factors are combined with excess pronation, this results in the foot dorsiflexing at the midtarsal joint which in turn places an extra strain on the plantar fascia.

Treatment

Biomechanical plantar fasciitis is best treated mechanically by neutralising abnormal foot mechanics.  ICB Orthotics are designed to control excess subtalar joint pronation as it will assist the arch in maintaining the correct longitudinal angle of 42° to the sagittal plane and in doing so, reduce and release plantar fascial tension.  Initially Low Dye strapping can be used if the patient or practitioner is unsure as to whether alternative treatment will be effective (see strapping link).  Usually immediate pain relief is experienced, however major reduction in symptoms will definitely be achieved within 24-72 hours.

In some cases surgery to detach the plantar fascia from the heel bone or removal of the bone spur is performed, however this has proved to not be that effective and should be avoided whenever possible - surgery is only required in a few extreme cases.

It is our experience through ICB Medical Distributors and the ICB Gait & Posture Clinics that over 90% of patients respond well to a practitioner heat moulding custom orthotics.

An ideal product to use for this condition is the ICB Dual Density* Orthotic which gives flexibility under the heel bone (calcaneus) whilst supporting and controlling the foot through the longitudinal arch and around the heel by using two different densities of EVA - a world first!

* patent pending

Content & Images © 2006 Footsteps Orthotics Pty Limited