Overview
Plantar Fasciitis is a common athletic injury of the foot. While runners are most likely to suffer from plantar fasciitis, any athlete whose sport involves intensive use of the feet may be vulnerable. The risk of plantar fasciitis increases in athletes who have a particularly high arch, or uneven leg length, though improper biomechanics of the athlete’s gait and simple overuse tend to be the primary culprits. If you suffer from plantar fasciitis or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, adding a few simple stretches to your fitness program will also help.
Causes
Far and away the most common cause of plantar fasciitis in an athlete is faulty biomechanics of the foot or leg. Faulty biomechanics causes the foot to sustain increased or prolonged stresses over and above those of routine ground contacts. Throughout the phase of ground contact, the foot assumes several mechanical positions to dissipate shock while at the same time placing the foot in the best position to deliver ground forces. With heel landing the foot is supinated (ankle rolled out). At mid-stance the foot is pronated (ankle rolled in). The foot is supinated again with toe-off. The supination of the foot at heel strike and toe-off makes the foot a rigid lever. At heel strike the shock of ground contact is transferred to the powerful quads. During toe-off forward motion is created by contraction of the gastroc complex plantar flexing the rigid lever of the foot pushing the body forward.
Symptoms
The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is often worse in the morning when you take your first steps, after standing or sitting for awhile, when climbing stairs, after intense activity. The pain may develop slowly over time, or come on suddenly after intense activity.
Diagnosis
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.
Non Surgical Treatment
Treatment of heel pain caused by plantar fasciitis begins with simple steps. There are a number of options for treatment of plantar fasciitis, and almost always some focused effort with nonsurgical treatments can provide excellent relief. In rare circumstances, simple steps are not adequate at providing relief, and more invasive treatments may be recommended. Typically, patients progress from simple steps, and gradually more invasive treatments, and only rarely is surgery required.
Surgical Treatment
If treatment hasn’t worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is released by making a cut into your heel, endoscopic or minimal incision surgery – where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to, have a “numbing” effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
Prevention
Preventing plantar fasciitis is crucial. There are many choices to help prevent the occurrence of this condition, and keep it from returning. One of the most important is maintaining a healthy weight in order to reduce tension on the plantar fascia. In addition, shoes are very important, and should fit well and provide ample cushioning and support throughout the heel, arch, and ball of the foot so that weight is distributed evenly throughout the foot. Try to avoid walking barefoot on hard surfaces and replace old shoes before they wear out, especially shoes that you run or exercise in. When exercising, start off slow and ease into new routines to prevent sudden or excessive stress on tissue. Lastly, keep your calf muscles and the tissue of your feet stretched. Greater flexibility in the tissue makes them less susceptible to damage.
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