Plantar fasciitis is a common, painful foot condition. Patients, and sometimes doctors often confuse the terms plantar fasciitis and heel spurs. Plantar fasciitis refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot; a heel spur is a hook of bone that can form on the heel bone (calcaneus). About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on x-ray.
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
Go to a podiatrist at the first sign of symptoms. Besides pain on the bottom of the foot, additional symptoms may include burning sensation in arch, difficulty standing on tiptoes, inflammation, more pain after sleeping or resting, redness, heat, localized pain in the ball of the foot, sharp or shooting pain in the toes, pain that increases when toes are flexed, tingling or numbness in the toes, aching, pain that increases when walking barefoot, pain that increases when walking on hard surfaces, pain the increases when standing (putting weight on your feet) or moving around and decreases when immobile, skin Lesions, it?s important to get a proper diagnosis and treatment plan. Let?s go over the possible causes of the pain.
A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to "raise up on the tip toes" of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet, the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.
Non Surgical Treatment
There is considerable debate about the best treatment option for plantar fasciitis. Some authors suggest all of the 'mainstream' methods of treatment don't actually help at all and can actually make the symptoms worse! However, on the whole, there are several of the most commonly cited treatment options for plantar fasciitis and these are generally accepted throughout the medical community. I would recommend giving these options a try if you haven't already. Rest. This is mainly applicable to the sports people as rest is possible treatment. (For those who cannot rest e.g. people who work on their feet - skip to the other treatment options below). Rest until it is not painful. This is made more difficult as people need to use their feet to perform daily activities but certainly stop sporting activities that are likely to be putting the fascia under excessive stress. Perform Self Micro-Massage (you can watch this video by clicking the link or scrolling further down the page as it's embedded on this lens!) This massage technique is used to break down fibrous tissue and also to stimulate blood flow to the area, both of which encourage healing and reduce pain. There is also a potentially soothing effect on nerve endings which will contribute to pain relief. Ice Therapy. Particularly useful after spending periods on your feet to reduce the inflammation. Wrap some ice or a bag of frozen peas in a towel and hold against the foot for up to 10 minutes. Repeat until symptoms have resolved. Heat Therapy. Heat therapy can be used (not after activity) to improve blood flow to the area to encourage healing. A heat pack of hot water bottle can be used. 10 minutes is ideal. Careful not to burn yourself! A good taping technique. By taping the foot in a certain way you can limit the movement in the foot and prevent the fascia from over-stretching and gives it a chance to rest and heal. Click on the link for more information on taping techniques. Weight Management. If you are over-weight, any weight you can loose will help to ease the burden on your sore feet and plantar fascia. Orthotic devices (often mis-spelled orthodic) are special insoles that can be used to limit over-pronation (discussed earlier) and control foot function. By preventing the arches flattening excessively, the plantar fascia is not over-stretched to the same extent and this should help with the symptoms and encourage healing. Stretching the calf muscles (again, click this link or scroll to the bottom of the page to watch the embedded video) can help to lengthen these muscles and the Achilles tendon - a risk factor for plantar fasciitis. Stretching of the plantar fascia itself is also encouraged, particularly before getting up the morning (night splints can be used for this effect) and after periods of rest. This can be achieved by placing a towel or band under the ball of the foot and gently pulling upwards until a stretch is felt. Hold for about 15-20 seconds then rest briefly. Repeat 2-3 times. As you can see there are many different treatment options available. Try incorporating some of these in to your daily routine and see what works for you. Regardless of the method the main aim is to prevent the fascia from over-stretching! Medical professionals such as a Podiatrist may decide to make custom orthotics or try ultra-sound therapy. It is likely that anti-inflammatory medications will also be recommended. If you have tried the treatment options and your symptoms persist I'd recommend going to see a medical professional for further advice.
The soft tissue surgeries usually would include a lengthening of the Achilles tendon, releasing of the plantar fascia as well as tendon transfers. These procedures are usually done in conjunction with bony procedures such as calcaneal osteotomies (to lower the heel bone and get it more under the leg itself), as well as metatarsal osteotomies. These procedures usually involve either cutting or fusion of the bones, and placement of fixation devices to allow the bones to heal. Healing time is usually at least 6-8 weeks and usually the patient must be non-weight bearing during the healing process. These types of surgical corrections are usually reserved for the more difficult, painful and deformed feet. They can require more surgeries down the line. These procedures are usually the last resort after all other modes of treatment have been exhausted (except in children where it is usually best to treat the deformity early). There are many different degrees of high arched feet and these procedures should be left for the more extreme cases. These cases usually require a very high degree of surgical skill and should only be done by those who frequently perform these types of cases.
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.
Stretching your calf and Achilles tendon may also help as a tight Achilles can make your foot overpronate. To stretch your calf and Achilles tendon, step forwards with your left leg and bend it, with your right leg straight and both feet pointing forwards. Push your right heel into the ground while keeping your right leg straight; you should feel the stretch at the back of your right leg, below the knee. Hold the stretch for 15 to 30 seconds and repeat with the opposite leg. Repeat the stretch two to four times on each leg, and repeat the overall exercise three to four times a day.