Plantar Fasciitis Treatment

Introduction

Plantar fasciitis is a thickening and degeneration of the tissue connecting heel and toes on the bottom of the foot. Plantar fasciitis is the most common musculoskeletal condition occurring in men. Roughly two million Americans have undergone treatment of plantar fasciitis. The old name for plantar fasciitis is  a heel spur and is as obsolete as notion that the plantar fascia gets inflamed during the process of disease. The most correct scientific name for plantar fasciitis is plantar fasciopathy because it describes the problem from the pathological perspective.

The plantar fascia (PF) is a tendon-like band of tissue that begins at the heel bone (calcaneus) and runs along the bottom of the foot, inserting itself into the transverse ligaments of the metatarsus, five long bones in the foot located between the toes and tarsal bones. The distal end of PF joins the metatarsophalangeal joints, it divides into five heads which branch out into a delta and continues onward to form fibrous sheaths that assist in holding the toes in place. Inserted into and surrounding the plantar fascia are small plantar nerves that register and mediate our position in space during walking, standing and moving. Unfortunately these receptors are also richly pain-innervated fibers as well.

The plantar fascia tissue is comprised of three distinct components: a medial component, a central component (plantar aponeurosis) and a lateral component, of which the central portion is the largest and strongest, and therefore most susceptible to injury. The plantar fascia works to provide tension and support throughout the arch of the foot , operating like a tension bridge to give both static support and shock absorption so that the body does not suffer from the tremendous pressure exerted when the foot collides with the ground. Plantar fascia also provides slinky like acceleration to the foot by actively or passively shortening the distance from the heel to toes thereby increasing the arch in attempt to create the fulcrum within the foot for propulsion during different phases of the human gate. According to some studies, the plantar fascia carries as much as 14 percent of the total load of the foot. Rupture of the plantar fascia may result in a decrease of arch stiffness and a collapse of the longitudinal arch.

Causes and Symptoms

Proper treatment for plantar fasciitis begins with understanding where it came from and how the patient acquired it. Because the heel is such a pivotal and vulnerable part of the body, plantar fasciitis has a variety of different causes.

Because the plantar fascia is like a rubber band, loosening and contracting as the body moves, plantar fasciitis may occur from an excess of exercise or other strenuous physical activity. This is why athletes and runners are so susceptible to it. Excessive running or jumping places pressure on the foot’s soft tissues that can lead to tears and inflammation. Athletes who suddenly increase the difficulty of their exercise routines may also damage their feet because the body has not adjusted to the pressure suddenly being inflicted on it.

Plantar fasciitis may also result from prolonged exposure to shoes that don’t fit properly or fail to support the weight of the body. Walking or running in these shoes may create an imbalance of weight distribution in which one foot is doing more of the heavy lifting than another, thereby placing huge amounts of force on the ligament of the plantar fascia. Wearing high-heeled shoes or boots may lead to plantar fasciitis over time. Having an abnormal gait or posture may cause the tissues to stretch abnormally, resulting in tears and inflammation.

Overweight and pregnant women are also vulnerable for the same reasons. Hormonal changes that occur during pregnancy may cause ligaments to become more pliable, putting women at risk for plantar fasciitis.

The pain of plantar fasciitis is typically caused by collagen degeneration at the origin of the plantar fascia, in the calcaneus, because of tears in the plantar fascia that overwhelm the body’s self-repair mechanisms. Patients undergoing treatment of plantar fasciitis will often complain of a burning or stabbing in the foot that’s especially prominent when they awaken in the morning. The fascia ligament tightens at night when the body is at rest, lessening pain, but when we get out of bed it becomes taut and sends pain shooting throughout the body. The pain usually lessens as the tissue re-adjusts, but the condition may worsen with prolonged physical activity, including sitting or standing.

MISCONCEPTION ABOUT PLANTAR FASCIITIS

The two most common misconceptions about plantar fasciitis is that stretching cures plantar fasciitis. Stretching during initial stage of plantar fasciitis is actually contraindicated. The next misconception is steroid injections. More than one steroid injection is proven to damage plantar fascia and worsen the condition by thinning plantar fat pad. The next misconception about plantar fasciitis is that most significant cause of plantar fasciitis is excessive pronation. The one single causative biomechanical reason of plantar fasciitis is the malfunctioned propulsion.

DIAGNOSIS

In the experience of the author which correlates with latest research plantar fasciitis should not be diagnosed solely on the grounds clinical evaluation as any physician who treats a large number of patients with heel pain and uses diagnostic ultrasonography can tell you how many patients are treated for non existent plantar fasciitis. Although high resolution ultrasonography is preferable to MRI both modalities are quite good for proper diagnosis. The next stage in diagnosis is biomechanical analysis as radiology only shows us the structure not the function. The video gait analysis combined with pressure analysis is the gold standard for evaluation of gait mechanics.

Treatment of Plantar Fasciitis

What is the best treatment for plantar fasciitis? It really depends on the needs of the patient. Plantar fasciitis is frequently misdiagnosed. Unless proven by diagnostic ultrasonography or MRI heel pain should not be quoted as plantar fasciitis as there are many other causes of heel pain. Even true severe chronic plantar fasciitis can be treated non-surgically with a combination of gait specific physical therapy and conventional methods such as orthotic inserts and extra-corporeal shockwave therapy (ESWT).

Patients often confuse home management of PF with treatment. Stretches are a good supportive measure against plantar fasciitis only in the chronic stage. Initially stretching should be avoided. The standing calf stretch, another physician-approved plantar fasciitis exercise, may be undertaken any time during the day. The patient faces and places his or her hands against a wall at eye level. Then, placing the injured leg behind him and the un-injured leg in front, with the heel of the injured leg resting on the floor, he makes a slight eversion (inward turn of the foot) and slowly leans into the wall until the back of the calf stretches slightly. Hold for 15 to 30 seconds, repeat three times a session, and perform as many sessions throughout the day as needed.

As simple as it sounds, self-massage is a proven and effective treatment for plantar fasciitis. The patient may massage his or her foot by placing a tennis ball or bottle of frozen water on the ground and gently rolling it under the foot for several minutes at a time. Using a tennis ball will help loosen the plantar fascia and make it less likely to be become irritated, while using a frozen water bottle will help to keep inflammation at bay. It’s normal to feel some soreness when massaging the foot, but stop if you begin to feel any pain and consult with your doctor.

In addition to these, a doctor may recommend the insertion of an orthotic, a shoe insert custom-made for the patient, in order to stabilize the foot. Elevating the foot by means of an orthotic prevents tearing and lengthening of the plantar fascia, thereby relieving stress and loading, while also preventing excessive pronation and correcting gait imbalances. However please note that foot stability can truly only come from within the foot and therefore orthotic is only recommended in the acute stage of disease.

Due to the short strides creating excessive up-and-down motion in the body that places undue pressure on the muscles, tendon, and plantar fascia, orthotics are especially helpful for slow runners who have injured themselves through tearing of the plantar fascia caused by asymmetrical running.

The Extracorporeal Shockwave therapy is, safe, non-invasive therapy  in which energy pulses are used to induce micro-trauma in the plantar fascia tissue that causes the body to repair those tissues. ESWT is recommended as an alternative for patients suffering from chronic plantar fasciitis for whom all the previous treatments have proven ineffective, and who are considering surgery to remedy the symptoms and relieve suffering.

How Do We Treat Plantar Fasciitis?

The good news is that for those staggering under the weight of chronic plantar fasciitis, the New York DNR has a variety of treatment options available. We utilize diagnostic ultrasound to visualize the soft tissue around the calcaneus where most damage is inflicted. Our physical therapists assess the primary and contributing factors of heel pain to determine the origin of the condition and the best treatment for plantar fasciitis. We then provide an advanced heel therapy that mobilizes the joints of the foot and dynamically lengthens the fibrous tissues, with gait specific maneuvers restoring them to their original function of supporting the foot’s weight.

Our safe, state-of-the-art, non-invasive and comprehensive diagnostic methods include high-resolution diagnostic ultrasonography, technological GAIT and running analysis to diagnose biomechanical faults during walking and running, as well as excessive stress to the tissues in the foot. Our special gait specific rehabilitative exercises strengthen and elongate muscles of the whole kinetic chain (hips, feet, and pelvis).

Our Computer Assisted Rehabilitation Environment (CAREN), treats and re-stabilizes the patient’s locomotion, and running, posture, balance, re-training the nervous system in symmetrical weight-bearing and lessening the damage caused by excessive forces and excessive loading .If the integrity of the tendons or muscle tissues is compromised, we combine rehabilitation with biological regenerative treatment, making use of extra-corporeal shockwave therapy (ESWT) to regenerate damaged tendons and muscles.

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