Overview
The plantar fascia is a sturdy structure but the degree of stress that it takes makes it susceptible to injury. A force equal to almost three times body weight passes through the foot with each step. On running, this typically happens about 90 times a minute. Plantar fasciitis is thought to be a traction and overuse injury. Damage to the plantar fascia is usually in the form of micro-tears. It is a degenerative rather than an inflammatory process. Damage tends to occur near the heel, where stress on the fibres is greatest, and where the fascia is the thinnest. The fascia broadens as it extends toward the toes.
Plantar fasciitis is often associated with calcaneal spurs. These are depositions of calcium where the fascia suffers most damage. Spurs are most commonly on the medial side at the origin of the fascia from the calcaneum. Spurs are the result of the process of plantar fasciitis and not the cause of the pain. It can present bilaterally.
Causes
Often, tarsal tunnel syndrome is misdiagnosed and confused with plantar fasciitis. Tarsal tunnel syndrome is when the tibial nerve which runs through the ankle, is pinched as it passes through the flexor retinaculum, the supportive band that surrounds the ankle joint. The symptoms of tarsal tunnel syndrome are often limited to the ankle but the since the nerve passes through the entire foot it can cause arch pain. Arch pain associated with foot strain is mainly caused by a pronated foot (rolls inward) or a flat foot. These are usually not singular causes of arch pain, but in combination with other factors, arch pain may result.
Symptoms
Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains.
Diagnosis
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
Non Surgical Treatment
There are many treatments for fasciitis. The most common initial treatment provided by the family doctor are anti-inflammatory medications. They may take the edge off the pain, but they don't often resolve the condition fully. Steroid injections, which deliver the medication directly to the most painful area, are usually more effective. Rest, ice, weight loss, taping, strapping, immobilization, physiotherapy, massage, stretching, heel cushions, acupuncture, night splints and extra-corporeal shock wave therapy all help some patients.
Surgical Treatment
Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.
Prevention
People who run regularly should replace shoes every six months, more frequently if an avid runner. Avoid running or stepping on uneven surfaces. Try to be careful on rocky terrain or hills with loose gravel. Holes, tree stumps and roots are problems if you are trail running. If you have problems with the lower legs, a dirt road is softer than asphalt, which is softer than concrete. Try to pick a good surface if possible. However, if you're racing, be sure to train on the surface you'll eventually run on. Be careful running too many hills. Running uphill is a great workout, but make sure you gradually build this up to avoid injuries. Be careful when running downhill too fast, which can often lead to more injuries than running uphills. Prevent recurrent injuries. Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries.
Stretching Exercises
Try these simple stretches to assist with relieving pain in your arches. (Note: Stretch slowly and gently. You should feel a moderate pull on the muscle and tendon but no pain. If these stretches are painful, stop and seek further advice from a health professional). STRETCH ONE. Stand at arm?s length from a wall with one foot in front of the other, forward knee bent. Keeping your back leg straight and back heel on the floor, lean into the wall until you feel a stretch in your calf. STRETCH TWO. This time, bend your back leg slightly, and lean into the wall. You should feel a stretch in the lower part of your calf. Hold each stretch for 20 seconds and repeat on each leg, a few times daily.
The plantar fascia is a sturdy structure but the degree of stress that it takes makes it susceptible to injury. A force equal to almost three times body weight passes through the foot with each step. On running, this typically happens about 90 times a minute. Plantar fasciitis is thought to be a traction and overuse injury. Damage to the plantar fascia is usually in the form of micro-tears. It is a degenerative rather than an inflammatory process. Damage tends to occur near the heel, where stress on the fibres is greatest, and where the fascia is the thinnest. The fascia broadens as it extends toward the toes.
Plantar fasciitis is often associated with calcaneal spurs. These are depositions of calcium where the fascia suffers most damage. Spurs are most commonly on the medial side at the origin of the fascia from the calcaneum. Spurs are the result of the process of plantar fasciitis and not the cause of the pain. It can present bilaterally.
Causes
Often, tarsal tunnel syndrome is misdiagnosed and confused with plantar fasciitis. Tarsal tunnel syndrome is when the tibial nerve which runs through the ankle, is pinched as it passes through the flexor retinaculum, the supportive band that surrounds the ankle joint. The symptoms of tarsal tunnel syndrome are often limited to the ankle but the since the nerve passes through the entire foot it can cause arch pain. Arch pain associated with foot strain is mainly caused by a pronated foot (rolls inward) or a flat foot. These are usually not singular causes of arch pain, but in combination with other factors, arch pain may result.
Symptoms
Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains.
Diagnosis
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
Non Surgical Treatment
There are many treatments for fasciitis. The most common initial treatment provided by the family doctor are anti-inflammatory medications. They may take the edge off the pain, but they don't often resolve the condition fully. Steroid injections, which deliver the medication directly to the most painful area, are usually more effective. Rest, ice, weight loss, taping, strapping, immobilization, physiotherapy, massage, stretching, heel cushions, acupuncture, night splints and extra-corporeal shock wave therapy all help some patients.
Surgical Treatment
Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.
Prevention
People who run regularly should replace shoes every six months, more frequently if an avid runner. Avoid running or stepping on uneven surfaces. Try to be careful on rocky terrain or hills with loose gravel. Holes, tree stumps and roots are problems if you are trail running. If you have problems with the lower legs, a dirt road is softer than asphalt, which is softer than concrete. Try to pick a good surface if possible. However, if you're racing, be sure to train on the surface you'll eventually run on. Be careful running too many hills. Running uphill is a great workout, but make sure you gradually build this up to avoid injuries. Be careful when running downhill too fast, which can often lead to more injuries than running uphills. Prevent recurrent injuries. Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries.
Stretching Exercises
Try these simple stretches to assist with relieving pain in your arches. (Note: Stretch slowly and gently. You should feel a moderate pull on the muscle and tendon but no pain. If these stretches are painful, stop and seek further advice from a health professional). STRETCH ONE. Stand at arm?s length from a wall with one foot in front of the other, forward knee bent. Keeping your back leg straight and back heel on the floor, lean into the wall until you feel a stretch in your calf. STRETCH TWO. This time, bend your back leg slightly, and lean into the wall. You should feel a stretch in the lower part of your calf. Hold each stretch for 20 seconds and repeat on each leg, a few times daily.