The plantar fascia is a thick band of connective tissue that runs along the underneath of the foot from the heel bone to the toes. At the heel it can also have fascial connections to the achilles
tendon. Its job is to maintain the arch of the foot, it acts as a bowstring pulled between the heel and the toes. "Itis" as a suffix indicates inflammation, but with the plantar fascia there is still
some controversy over what exactly happens to the tissue when it becomes painful.
This is a problem of either extreme, so people with high arches or those that have very flat feet are at risk of developing pain in this region. This is because of the relative stress the plantar
fascia is put under. In people with excessive pronation, the plantar fascia is put under too much stretch, as their range flattens and strains it. People with a stiff, supinated (high-arched) foot
lack the flexibility to appropriately shock absorb, so this too puts extra strain on the plantar fascia. Clinically, we see more people presenting with plantar fascia pain who have excessive
pronation than those with stiff, supinated feet. But while the foot type is the biggest risk factor for plantar fasciitis, the whole leg from the pelvis down can affect how the foot hits the ground.
A thorough biomechanical assessment will determine where in the kinetic chain things have gone wrong to cause the overload.
Patients experience intense sharp pain with the first few steps in the morning or following long periods of having no weight on the foot. The pain can also be aggravated by prolonged standing or
sitting. The pain is usually experienced on the plantar surface of the foot at the anterior aspect of the heel where the plantar fascia ligament inserts into the calcaneus. It may radiate proximally
in severe cases. Some patients may limp or prefer to walk on their toes. Alternative causes of heel pain include fat pad atrophy, plantar warts and foreign body.
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate
WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its
insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests
(including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
Many cases of plantar fasciitis can be treated with simple, conservative measures. These include ice packs, stretching exercises, anti-inflammatory medications, orthotic devices (custom molded
orthotics), and physical therapy. Itâs important to consult your doctor before you take any medications to treat this condition. In chronic or persistent cases, one of three techniques may be used
to treat plantar fasciitis. Extracorporeal Shock Wave Treatment (ESWT). TOPAZ treatment. Platelet Rich P
More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured
fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are
sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if
it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.