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PLANTAR FASCITIS.

Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of each foot and connects the heel bone to the toes (plantar fascia).


  • The plantar fascia plays an important role in the normal biomechanics of the foot.

  • The fascia itself is important in providing support for the arch and providing shock absorption.





Etiology

  • Overuse injury: that is primarily due to a repetitive strain causing micro-tears of the plantar fascia.

  • Trauma or other multifactorial causes.

  • Some predisposing factors are pes planus, pes cavus, limited ankle dorsiflexion, and excessive pronation or supination. Pes planus can cause increased strain at the origin of the plantar fascia. Pes cavus can cause excessive strain on the heel because the foot does not effectively evert or absorb shock. Tight gastrocnemius, soleus, and/or other posterior leg muscles have also been commonly found in patients with this condition. It is thought that these tight muscles can alter the normal biomechanics of ambulation.

  • Heel spur: Approximately 50% of patients with this condition will also have heel spurs, but the spurs themselves are not the cause.

  • often associated with runners and older adults, but other risk factors include obesity, heel pad atrophy, aging, occupations requiring prolonged standing, and weight-bearing.


Pathophysiology

  • This condition is primarily a degenerative process.

  • The constant stretching of the plantar fascia results in chronic degeneration of the fasica, eventually leading to pain during sleep or at rest.



Symptoms

  • Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel.

  • The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up from sitting.


Evaluation


  • Plantar fasciitis is a clinical diagnosis

  • X-rays and/or ultrasound evaluation may show calcifications in the soft tissues or heel spurs on the inferior aspect of the heel.







Medical Management

Conservative measures are the first choice

  • Relative rest from offending activity as guided by the level of pain should be prescribed.

  • Ice after activity as well as oral or topical NSAIDs can be used to help alleviate pain.


  • Shoe inserts or orthotics and night splints may be prescribed in conjunction with the above.

  • Educate patients on proper stretching and rehab of the: plantar fascia; Achilles' tendon; gastrocnemius; and soleus.




If the pain does not respond to conservative measures

  • More advanced or invasive techniques may be tried eg extracorporeal shock-wave therapy , autologous platelet-rich plasma or steroid injections.

  • Important that advanced and invasive techniques be combined with conservative therapies.

  • Surgery should be the last option if this process has become chronic and other less invasive therapies have failed.


Physical Therapy:

1. Plantar Fascia Massage

Note: You should not experience pain during this exercise. Apply enough pressure to feel a gentle stretch, but not pain.

  • Sit in a chair or stand with one foot resting on a small ball or frozen water bottle. A frozen water bottle is useful as the ice helps reduce inflammation.

  • Gently roll the ball or water bottle forward and backward under your foot. Start at just below the ball of your foot and end just before your heel.

  • Roll the ball or bottle back and forth slowly 10 times for each foot. Do two sets per foot.

  • Do this exercise once daily.



2. Heel Raise

Note: This exercise should be done slowly and with controlled movements. Make sure to maintain your balance and hold on to a railing or other support if needed.

  • Stand with the balls of your feet at the edge of a bottom step.

  • With your heels hanging off the edge, slowly and gently lower your heels just below the edge of the step. You may feel a stretch in your calf muscle.

  • Slowly rise onto the balls of your feet.

  • Repeat this 10 times, then rest. Complete two sets of this exercise.

  • Do this exercise once daily.



3. Seated Plantar Fascia Stretch

Note: Complete this stretch in a slow and controlled manner.

  • Sit in a chair and cross one leg over the other knee, so your ankle is on top of your other leg.

  • With one hand holding your ankle and the other holding your toes, gently pull your toes backward until you feel a stretch in the bottom of your foot.

  • Hold this position for 20 seconds and repeat three times for both feet.

  • Do this exercise once daily.



4. Wall-Facing Calf Stretch

  • Stand upright facing a wall at arm’s length and place your hands flat on the wall.

  • Keeping both feet flat on the floor, extend one leg straight backward, bending your front leg until you feel a stretch in the calf of your back leg.

  • Hold for 20 seconds and repeat three times for both legs.

  • Do this exercise once daily.



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