What is the plantar fascia and the condition plantar fasciitis?
-- by AM Rogers--Reviewed and edited by David J. Micca, DPM, FACFAS, CWS, FCCWS

The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. It extends from the heel to the bones of the ball of the foot and acts like a rubber band to create tension which maintains the arch of the foot. If the band is long, it allows the arch of the foot to be low, which is most commonly known as having a flat foot.

A short band of tissue causes a high arch. This fascia can become inflamed and painful in some people, making walking more difficult.

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Risk factors for plantar fasciitis

Risk factors include both flat feet and high arches, sudden weight gain, running, and a tight Achilles tendon which is the tendon connecting the calf muscles to the heel. It is a typical sports medicine injury for runners.

Sudden weight gain can cause plantar fasciitis when it changes your COM (center of mass). It is very similar to a person who is carrying a heavy box in front of them. They abduct their feet. When the feet are abducted (go out to the side), it puts strain on the medial band of the plantar fascia. Over time it becomes inflamed.

The bottom line is that plantar Fasciitis occurs for two reasons--

>Overuse syndrome- The overuse syndrome resolves very quickly with the treatments listed below.

>Abnormal biomechanics- There are many foot and ankles types that predispose runners to this condition which requires a different approach.

Symptoms

The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

Plantar fasciitis can be agonizingly slow to heal. Duration of treatment can be anywhere from several months to 2 years before symptoms resolve. However, 90% of patients improve in 9 months.

What is the treatment for Plantar Fasciitis?

Treatment for the overuse cause of plantar fasciitis begins with heel stretching exercises, shoe orthotic inserts, night splints, and anti-inflammatory medications. If these don't resolve the condition, a walking cast is applied for several weeks and is usually successful in reducing pain and inflammation. A cast boot are sometimes used. It is worn full time, but can be removed for bathing. This can be a fashion dilemma for women who love shoes.

The treatment of plantar fasciitis is relatively simple, yet it may take 6 to 12 weeks or more for symptoms to resolve. In general, the longer symptoms have been present and the more severe the pain, the longer the condition may take to respond to treatment.

The key components to overuse syndrome treatment are as follows :

• Rest and activity modification : decreasing distances and duration of walking or, particularly, running; switching from jumping or running activity to activities such as swimming or cycling to reduce the stress on the foot; changing the exercise surface (ie. from concrete to dirt path)


• Massage: local, deep massage to the area of pain at the heel (where the fascia attaches); usually done in the morning after a warm bath or shower


• Stretching: most important; requires routine, daily stretching of the heel cord and plantar fascia to help stretch and "recondition" the tight structures

Steroid injections are sometimes used although this injection is very painful and provide relief in about half of patients. As a last resort, surgery can release the tight, inflamed fascia.

The key components to abnormal biomechanics treatment are as follows :

• Getting treatment right away and not applying "bandaids" to the problem like strapping sleeves
• Knowing how to correct these abnormal mechanics is usually provided by a bomechanist who can correct with appropriate functional orthotics
• Knowing how to correct these abnormal mechanics is usually provided by a bomechanist who can help find the correct running shoes that won't exacerbate the runner's problem.