by THOMAS on Mar 18, 2014 • 6:00 pm
Plantar fascitis presents itself with symptoms of burning, stabbing, or aching pain in the bottom of the foot usually near the heel, but can also be in the middle or even the forefoot area. It is caused by pressure building up on the bottom of the foot due to lack of support in the arches. The transverse and longitudinal arches provide support and stabilization of the foot, allowing the foot to act as a shock absorber as the heel strikes the ground during the gait cycle. Plantar fascitis takes years to develop and usually begins to rear its ugly head at mid life. It can last for months, and in some cases years and may never resolve without the proper treatment.
The foot is made up of 26 bones that are held in place by connective tissues namely muscles, tendons, and ligaments. The two most important functions of the foot are ambulation and shock absorption. The shock absorption feature is due to the presence of a transverse and longitudinal arch. These arches are designed to prevent excessive impact from traveling up the kinetic chain and into the ankle, knee, hip, low back, shoulder girdle and neck. Over time these supporting structures can become fatigued due to a history of standing for long periods, ankle and foot injuries, or repetitive athletic activities. This can cause a gradual loss of support as the arches begin to collapse. This, in turn, will result in a gradual build up of pressure in the plantar fascia, causing it to begin pulling on the calcaneus (heel) tubercle. This can cause a spur(s) to develop as the body tries to prevent the tendon attachment from pulling away from the bone. It can also cause the same thing to occur at the opposite end of the foot and affect the bones of the forefoot. The resulting pain can become debilitating as the body attempts to prevent further damage to the plantar fascia.
Proper treatment should focus on restoring normal foot and ankle function. Manipulation of the joints and soft-tissues of the foot, ankle, knee, hip, and low back would be a good place to start. Next the ankle/ foot relationship should be assessed to determine if any instability or hypermobility exists and this should be addressed through proper taping procedures. Finally an orthotic, which is a functional foot appliance, should be employed to provide additional support and restore function. Home care instructions should include ice and warm water submersion of the foot, followed by stretching of the plantar fascia, and taping of the tibia-fibula joint 24/7 to stabilize if needed. And finally, with the patient in a seated position first, the use of a small, golf ball size super ball to be placed on the floor while the patient slowly rolls the ball around the bottom of the foot. If the patient’s symptoms are severe, activities should be limited to allow sufficient time for recovery.
The proverbial question is always, “how long will it last or how soon should I expect improvement?” It depends upon the patient’s age, the nature and severity of the problem, how long the patient has had plantar fascitis, and how compliant the patient is with their home care program. I have seen cases that have cleared up in a matter of days and then others that have taken weeks or months.
If you would like additional information or to schedule a consultation, please contact the clinic.