What is plantar fasciitis? Probably the most common cause of heel pain. Symptoms come on gradually and are often worse first thing in the morning. The plantar fascia is the tissue under the foot which forms the arch. Treatment includes rest, reducing pain and inflammation and stretching exercises.
Causes
Plantar fasciitis is an overuse injury caused by repetitive over-stretching of the plantar fascia which is is thick band of tissue / tendon that runs under the foot leads to possible inflammation and thickening of the tendon. Through overuse the fascia can become inflamed and painful at its attachment to the heel bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of actual inflammatory cells within the fascia and degeneration is thought to be a more likely cause.
It is more common in sports which involve running, dancing or jumping. Although overuse is ultimately the cause of injury, there are a number of factors which can increase the likelihood of developing it including overpronation, a high arched foot, tight calf muscles, poor footwear, being overweight and previous injury.
Symptoms
Symptoms of plantar fasciitis consist of a gradual onset of pain under the heel which may radiate forwards into the foot (foot arch pain). There may be tenderness under the sole of the foot and on the inside of the heel when pressing in. The pain can range from being slightly uncomfortable to very painful depending on how badly it is damaged. Pain is usually worse first in the morning because the foot has been in a relaxed position all night and the plantar fascia temporarily shortens. After walking around this usually eases as the tissues warm up and gradually stretch out. When the condition is present, similar periods of moving around following inactivity such as sitting for long periods can also trigger the pain.
Physiotherapy Treatment:
Contrast bath:
This the good pain relieving method of application, which consists of alternative hot and cold water application for the period of 10 secs with the intermittent period of two secs.
Ultrasound therapy:
It gives more pain relieve and helps to heal the injured points or areas to recover rapidly.
Strength Training. Similar to tendinopathy management, high-load strength training appears to be effective in the treatment of plantar fasciitis. High-load strength trainingmay aid in a quicker reduction in pain and improvements in function.
Stretching consists of the patient crossing the affected leg over the contralateral leg and using the fingers across to the base of the toes to apply pressure into toe extension until a stretch can be felt along the plantar fascia. Achilles tendon stretching can be performed in a standing position with the affected leg placed behind the contralateral leg with the toes pointed forward. The front knee was then bent, keeping the back knee straight and heel on the ground. The back knee could then be in a flexed position for more of a soleus stretch. In my experience frequent soleus stretching gives better relief the pain as well as plantar fascitis.
Mobilizations and manipulations have also been shown to decrease pain and relieve symptoms in some cases. Posterior talocrural joint mobs and subtalar joint distraction manipulation have been performed with the hypomobile talocrural joint.
Posterior-night splints maintain ankle dorsiflexion and toe extension, allowing for a constant stretch on the plantar fascia. Some evidence reports night splints to be beneficial but in a review reported that there was limited evidence to support the use of night splints to treat patients with pain lasting longer than six months, and patients treated with custom made night splints improved more than prefabricated night splints. It gives desired effects
Six treatments of acetic acid iontophoresis combined with taping gave greater relief from stiffness symptoms than, and equivalent relief from pain symptoms to, treatment with dexamethasone/taping. For the best clinical results at four weeks, taping combined with acetic acid is the preferred treatment option compared with taping combined with dexamethasone or saline iontophoresis.
Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device whether they are custom made or prefabricated. When used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.
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