Plantar Fasciitis  (Plantar fasciopathy)

What is it?
Plantar fasciitis: is the term used to describe the inflammation of the plantar fascia.

Do you get heel pain in your foot that is worse during those first few steps out of bed in the morning? Or does your heel hurt after jogging, playing sport or even a long day on your feet? If so you may be suffering from plantar fasciitis. Please note, if you have had these symptoms for more than a week or so, it is more likely that you are suffering from Plantar fasciosis.

Plantar fasciitis is caused by an inflammation of the plantar fascia (the tissue along the bottom of your foot that connects your heel bone to your toes). Plantar fasciitis causes stabbing or burning pain that's usually worse in the morning. Once your foot limbers up, the pain of plantar fascia normally decreases, but it may return after long periods of standing or after getting up from a seated position.

In most cases, you can overcome the pain of plantar fasciitis without invasive treatments as well as take the steps to prevent plantar fasciitis from recurring or plantar fasciosis developing.

Cause
Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia and can cause the ligament to separate from the heel bone, fibre by fibre. Gradual tearing of this ligament leads to inflammation and inflammation of this plantar fascial ligament is called plantar fasciitis. In long term cases when inflammation has subsided and there is a delay or disruption in the healing process, degeneration can occur and is more appropriately termed "plantar fasciosis". More discussion of plantar fasciitis vs fasciosis.

A bone spur (heel spur) may form if this injury continues, where  calcium is deposited near the heel in an attempt to "glue" the detached fibres back onto the heel. The bone spur itself has no nerve endings and doesn't hurt, however, this is a sign that overuse of this area has been present for sometime.

Symptoms
Plantar fasciitis usually develops suddenly and often occurs after an injury or a long day on the feet and can be severe.  Although it can affect both feet, it more often presents in only one foot at a time.

Symptoms to watch for:
 - Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking into the bottom of your foot.
 - Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe.
 - Heel pain after long periods of standing or after getting up from a seated position.
 - Heel pain after, but not usually during, exercise (unless there is a larger tear present).
 - Mild swelling in your heel.

Causes
Increased physical activity and overload. Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regime. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
Changes in footwear or poor choice of foot wear. Shoes that are thin-soled, loose, lack arch support or the ability to absorb shock don't protect and in some cases cause added stress to your feet. If you regularly wear shoes with high heels, your Achilles tendon (which is also attached to your heel) can contract and shorten, causing strain on the tissue around your heel and walking abnormalities.
Recent weight gain- the extra weight on your feet can lead to an over load on your feet, including of the plantar fascia, causing it damage.
Low arch (flat feet / over-pronation) or high arched (rigid feet) or abnormal walking patterns can adversely affect the weight is distribution when you're on your feet, putting added stress on the plantar fascia.
Trauma which involves excessive pull on the plantar fascia.
Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
Diabetes. There may be a link between plantar fasciitis and diabetes. However more specific research is still required.
Tight Achilles tendon This may cause excess strain on the plantar fascia.
Pressure and strain on your feet from long hours of walking or standing such as in factory or retail workers.

Tests & Diagnosis
Your doctor or Podiatrist will ask you about your symptoms and look for points of tenderness in your foot. This can help rule out other causes of heel pain, such as other tendinitis, fractures, arthritis, nerve irritation, cysts etc. Your Podiatrist may also suggest an ultra sound to confirm the diagnosis which will most likely show swelling or damage to the local area and may even order a X-ray to rule out the possibility of a stress fracture or other pathology.

Treatment
Initial treatment includes: Treatments for plantar fasciitis which is still in the inflammatory phase and can last at most up to a few weeks.
 - Ice for 10-20 mins, two - three times a day. The easiest way to do this is freeze a 600ml plastic bottle of water and roll the arch of your foot over it gently.
 - Panadol/Aspirin/NSAIDS. These will help take down the inflammation in true plantar fasciitis as well as the pain, however often does little in long term cases where the pain is most likely from degeneration.
 - Shoes. Wearing sensible shoes especially when running
 - Preventing Harmful Activity,by reducing the activity that caused the problem in the first place is a major step to over coming plantar fasciitis. Remember to take care when walking up or down stairs, standing on ladders, kneeling or squatting as this can also be aggravating.
 - Voltarin Gel massage. Questionable effect and may be placebo however some people find it affective.
 - Low Dye taping for the feet that can be performed by your podiatrist and taught to self application.
 - Rest, is crucial during the first few days.
 - Orthotics to correct abnormal walking.

Prevention
 - Maintain a healthy weight. This minimizes the stress on your plantar fascia.
 - Choose supportive shoes. Forget the stilettos for the time being and avoid shoes with excessively low heels such as soccer boots, as well. Shoes with a low to moderate heel are best. Other features that are important include a good arch support, firm support around the heels and shock absorbency. Try to avoid going barefoot as much as possible, especially on hard surfaces and avoid shoes that are too too soft which can cause added stress to feet as well.
 - Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new running shoes after every 3 months or so of use, if not every 6 months or so for those with problem feet.
 - Start sports activities slowly. Warm up before starting any athletic activity, gym program or sport, and start a new exercise program slowly as plantar fasciitis is often seen in the "Weekend Warrior" or when the 40 something year old man, decides to become a runner for the first time in his life and goes too hard on his feet.
 - Stretch, Stretch, Stretch. Before you do any activities or even before going to work for the day give your arch and Achilles Tendon a good (but gentle) stretch. Stretching the arch helps reverse the tightening  of the plantar fascia that occurs overnight and encourages agility.


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