Plantar Fasciosis
Plantar fasciosis: is the term used to describe the heel pain caused by degeneration (deterioration) of the plantar fascia which often occurs as a result of repetitive stress. The most common pain experienced with plantar fasciosis (the non inflamed phase of plantar fasciopathy) is pain after sitting or first step in the morning, and less likely to occur all day or all towards the end of the day which is more likely to be plantar fasciitis (the inflamed phase of plantar fasciopathy).
As most cases of plantar fasciitis tend to progress to plantar fasciosis with re-bouts of inflammation, plantar fasciopathy has become a more appropriate term for this condition is it covers both the inflamed and the denegerated phases of the condition. Unfortunately, plantar fasciosis (the degenerated and non-inflamed phase of plantar fasciopathy) is much more difficult to treat when individuals fail to recognise it as the non inflamed phase of the condition and continue to treat it as though it were inflamed and rehab of the degenerated area does not occur.
* Due to number of differential diagnosis it is important that you see your podiatrist as there are other heel problems that closely mimic plantar fasciosis such as chronic heel pain syndrome. medial calcaneal nerve impingement, tarsal tunnel syndrome, stress fracture of the calcaneous, fat pad impingement, heel bursa's and more....
In most cases, you can overcome the pain of plantar fasciosis without surgery or other invasive treatments as well as take the steps to prevent plantar fasciitis from recurring or plantar fasciosis developing.
Symptoms
Plantar fasciosis usually develops over time after plantar fasciitis has subsided. 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 chronic swelling in your heel that has been present for some time.
Causes
The causes of plantar fasciosis are similar to plantar fasciitis and include:
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/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.Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis and progress to plantar fasciosis.
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 or tendinosis', 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
- Preventing Harmful Activity,by reducing the activity that caused the problem in the first place is a major step to over coming plantar fasciosis. Remember to take care when walking up or down stairs, standing on ladders, kneeling or squatting as this can also be aggravating..
- Orthotics to correct abnormal walking and to limit excessive pronation and minimise destructive forces when present.
- Shoes. Wearing sensible shoes is a vital part to preventing negative forces on the fascia.
- Stretching of the Achilles tendon and plantar fascia. Stretching of the Achilles tendon is beneficial in people with a tight achilles tendon. It helps to reduce the destructive forces on the plantar fascia. Stretching of the plantar fascia is vital to promote correct alignment of the collagen fibres as they heal and should be done each day.
- Strengthening exercises prescribed by your podiatrist. These may include such exercises as picking up marbles or scrunching up a towel with your toes. These exercises help strengthen the intrinsic muscles of the feet which improve foot function.
- Massage of the plantar fascia helps to promote blood flow and healing in the area.
- Warmth, such as that from a wheat bag may be indicated to assist with the rehabilitative process once inflammation has been ruled out.
- Ice Massage's can be effective in reducing pain in some cases and can be done by freezing a 600ml bottle of water and rolling your heel on it firmly.
- Acupuncture
- Ultrasound
- Extracorporeal shock wave therapy to be prescribed if conventional therapies have failed.
- Cortisone via injections / or iontophoresis and ultrasound.
- Below knee casting / or dorsiflexion heel splint. (less likely to be used)
- Night Splint stretching
- Surgery Less than 5% require surgery and even then its not often warranted. This type of surgery can be performed by an orthopaedic surgeon.
Once the pain of plantar fasciopathy is no longer present, it is important to continue on with the rehabilitation of the fascia for several months. This rehabilitation includes massage, warmth, and gentle stretches of the fascia
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. Click here for Tips on running shoes
- 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 and plantar fasciosis 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 gently.
As most cases of plantar fasciitis tend to progress to plantar fasciosis with re-bouts of inflammation, plantar fasciopathy has become a more appropriate term for this condition is it covers both the inflamed and the denegerated phases of the condition. Unfortunately, plantar fasciosis (the degenerated and non-inflamed phase of plantar fasciopathy) is much more difficult to treat when individuals fail to recognise it as the non inflamed phase of the condition and continue to treat it as though it were inflamed and rehab of the degenerated area does not occur.
* Due to number of differential diagnosis it is important that you see your podiatrist as there are other heel problems that closely mimic plantar fasciosis such as chronic heel pain syndrome. medial calcaneal nerve impingement, tarsal tunnel syndrome, stress fracture of the calcaneous, fat pad impingement, heel bursa's and more....
In most cases, you can overcome the pain of plantar fasciosis without surgery or other invasive treatments as well as take the steps to prevent plantar fasciitis from recurring or plantar fasciosis developing.
Symptoms
Plantar fasciosis usually develops over time after plantar fasciitis has subsided. 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 chronic swelling in your heel that has been present for some time.
Causes
The causes of plantar fasciosis are similar to plantar fasciitis and include:
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/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.Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis and progress to plantar fasciosis.
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 or tendinosis', 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
- Preventing Harmful Activity,by reducing the activity that caused the problem in the first place is a major step to over coming plantar fasciosis. Remember to take care when walking up or down stairs, standing on ladders, kneeling or squatting as this can also be aggravating..
- Orthotics to correct abnormal walking and to limit excessive pronation and minimise destructive forces when present.
- Shoes. Wearing sensible shoes is a vital part to preventing negative forces on the fascia.
- Stretching of the Achilles tendon and plantar fascia. Stretching of the Achilles tendon is beneficial in people with a tight achilles tendon. It helps to reduce the destructive forces on the plantar fascia. Stretching of the plantar fascia is vital to promote correct alignment of the collagen fibres as they heal and should be done each day.
- Strengthening exercises prescribed by your podiatrist. These may include such exercises as picking up marbles or scrunching up a towel with your toes. These exercises help strengthen the intrinsic muscles of the feet which improve foot function.
- Massage of the plantar fascia helps to promote blood flow and healing in the area.
- Warmth, such as that from a wheat bag may be indicated to assist with the rehabilitative process once inflammation has been ruled out.
- Ice Massage's can be effective in reducing pain in some cases and can be done by freezing a 600ml bottle of water and rolling your heel on it firmly.
- Acupuncture
- Ultrasound
- Extracorporeal shock wave therapy to be prescribed if conventional therapies have failed.
- Cortisone via injections / or iontophoresis and ultrasound.
- Below knee casting / or dorsiflexion heel splint. (less likely to be used)
- Night Splint stretching
- Surgery Less than 5% require surgery and even then its not often warranted. This type of surgery can be performed by an orthopaedic surgeon.
Once the pain of plantar fasciopathy is no longer present, it is important to continue on with the rehabilitation of the fascia for several months. This rehabilitation includes massage, warmth, and gentle stretches of the fascia
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. Click here for Tips on running shoes
- 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 and plantar fasciosis 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 gently.
