What is Plantar Fasciitis(Heel pain)?
Plantar Fasciitis is the Latin term for “inflammation of the plantar fascia”. The plantar fascia is a thick, fibrous ligament that runs under the foot from the heel bone to the toes. It forms the arch of the foot and functions as our natural shock-absorbing mechanism. Unlike muscle tissue, the plantar fascia is not very elastic and therefore is very limited in its capacity to stretch or elongate. Herein lies the problem: when too much traction is placed on the plantar fascia (for various reasons) micro-tearing will occur, resulting in irritation, inflammation and pain.
Plantar Fasciitis usually causes pain under the heel. However some people may experience pain under the arch of the foot. Both heel pain and arch discomfort are related to Plantar Fasciitis, with heel pain being far more common than arch pain.
The pain is more intense with your first steps out of bed in the morning or after sitting for a while. The reason for this is that during rest our muscles and ligaments tend to shorten and tighten up. The tightening of the plantar fascia means more traction on the ligament making the tissue even more sensitive. With sudden weight-bearing the tissue is being traumatised resulting in a stabbing pain.
After walking around for a while the ligament warms up, becomes a little bit more flexible and adapts itself, making the pain go way entirely or becoming more of a dull ache. However, after walking a long distance or standing for hours the pain will come back again.
To prevent the sudden sharp pain in the morning or after sitting, it is important to give the feet a little warm-up first with some simple exercises. Also, any barefoot walking should be avoided, especially first thing in the morning, as this will damage to the plantar fascia tissue.
What are the main causes?
The main cause of pain is overstretching of the plantar fascia ligament under the foot. So why is the ligament being overstretched? There are different factors:
- over-use:too much sports, running, walking or standing for long periods (e.g. because of your job)
- weight gain: our feet are designed to carry a ‘normal’ weight. Any excess weight places great pressure on the bones, nerves, muscles and ligaments in the feet, which sooner or later will have consequences. Even pregnancy (in the last 10 weeks) can cause foot problems!
- age: as we get older ligaments become tighter & shorter and muscles become weaker; the ideal circumstances for foot problems
- unsupportive footwear:‘floppy’ shoes with no support as well as thongs affect our walking pattern
- walking barefoot:especially on hard surfaces like concrete or tiles
- low arch/flat feet or over-pronation
An important contributing factor to Plantar Fasciitis is ‘excess pronation’ (or over-pronation). This is a condition whereby the feet roll over, the arches collapse and the foot elongates. This unnatural elongation puts excess strain on the ligaments, muscles and nerves in the foot.
When the foot is not properly aligned, the bones unlock and cause the foot to roll inward. With every step taken your foot pronates and elongates, stretching the plantar fascia and causing inflammation and pain at the attachment of the plantar fascia into the heel bone. Re-alignment of the foot should therefore an important part of the treament regime.
Physical medicine treatments are performed to decrease pain and inflammation in the soft tissue of the foot. Ice, heat, and ultrasound are very common treatment modalities. Once the pain and inflammation decreases to appropriate levels, stretching and strengthening activities may be performed. Stretching the gastrocnemius and soleus muscles are important in helping the lower leg.
Specific balance exercises can be given to increase foot strength and endurance. Often times patients have weakness in their ability to stand on one foot with their eyes closed while maintaining their balance. This lack of proprioceptive ability results in excessive strain on the lower leg and foot during running. Properly strengthening these muscles helps relieve stress on the tissues and ultimately allows the fascia to heal. Exercises can be performed on the ground, unstable surface such as a BOSU ball, foam, or vibration plate. The more difficult and challenging the surface the more the body is challenged and will improve.
A trigger point is an irritable knot in the muscle tissue. When pressed trigger points are very tender and can cause pain in that specific spot or elsewhere in the body (referred pain). The response to pushing into the knot is a muscle twitch.
The foot contains 126 muscles, tendons and ligaments, so there are plenty of ‘hiding places’ for trigger points. Trigger points in the calf muscles often refer pain directly to the bottom of the foot. Trigger point therapy of the lower leg and foot can therefore be successful in the treatment of plantar fasciitis.
The Strassbourg Sock consists of a tubular fabric with two adjustable straps which extends from the toes to the lower leg. The aim is to keep tension on the plantar fascia ligament all night long, so no tightness occurs overnight and little or no pain is experienced in the morning. In combination with orthotic insoles and exercises, this device can be very effective indeed. In independent study published in the Journal of Foot and Ankle Surgery found some significant improvement in 55% of the participants.
Laser Treatment of Plantar Fasciitis
The major goal of therapy is to relieve pain and increase functional ability. Currently used treatments include complementary methods out of which LLLT (low Level Laser Therapy), is one of the most common. To conclude LLLT could produce pain relief by one or a combination of these mechanisms – collagen proliferation, anti-inflammatory effect, circulation enhancement, and peripheral nerve stimulation. Thus, there have been adequate physiological effects and evidences for the significant role of LLLT in Plantar fasciitis.
The laser safely and painlessly penetrates deep tissue. This non-invasive treatment stimulates the plantar fascia to heal. Most patients respond after six to eight treatments.
Taping for plantar fasciitis aims to reduce the strain on the plantar fascia which in turn reduces or eliminates painful symptoms. In effect the tape unloads some of the strain on the plantar fascia allowing the tissues to heal. It may need to be applied regularly until symptoms resolve but many people notice an immediate improvement.