Plantarfasciitis - what is it?

What is the Plantar fascia?

The Plantar fascia is a thick fibrous band of connective tissue situated on the sole of the foot. The Plantar fascia is not a muscle. It originates from a narrow attachment on the inside portion of the calcaneus (heel bone) and travels forwards and outwards to its broad attachment on the whole length of the ball of the foot. It is triangular in shape.

What is the Plantar fascia’s normal function?

The Plantar fascia acts to stop the over-flattening of the arch of the foot.

What is Plantar Fasciitis ?

Plantar Fasciitis is the medical term used for the process of small tears or irritation of the Plantar fascia. Typically, this occurs at the attachment point of the Plantar fascia around the heel or in the middle of plantar fascia structure.

What causes Plantar Fasciitis ?

Plantar Fasciitis is usually caused by either an ongoing tractioning (sustained over stretching) or compression (squashing) of the area.

There are several factors that can lead to this traction or compression of the Plantar fascia:

Poor foot mechanics – This can include excessive foot pronation or “flat feet” causing an elongated foot arch (over-stretching of the structure). It can also include weak foot muscles which lead towards weak arches.

Poor lower limb mechanics – This can include but is not exclusive to tight Achilles tendons, weak Gluteal muscles or a “knocked knee” posture. As a result of these imbalances, the Plantar fascia has to work harder and becomes overloaded.

Poor footwear – This is generally due to a lack of arch support in footwear such as jandals or street shoes like Converse or Vans. This causes an overstretching of the Plantar fascia leading to symptoms. Another contributing factor to Plantar fascia is wearing shoes with hard innersoles such as dress shoes. Finally, high heels are not recommended when someone is suffering from Plantar Fasciitis as the extra heel height causes compression of the Plantar Fascia.

Environmental factors – Plantar Fasciitis is more common in people who stand all day and therefore the Plantar Fascia is not allowed to rest. Alternatively, somebody who is very active and partakes in regular sport (particularly running sports) can suffer from Plantar fasciopathy.

Bony spurs on heel bone – Calcaneal (heel bone) spurs can occur as the Plantar fascia has pulled on its attachment to the Calcaneus for a long time and has been overstretched.

Trauma – Stepping on a sharp, hard object such as a stone or a nail for example can result in an insult to the Plantar fascia and Plantar fasciitis results.

Weight – The heavier a person is, invariably the more weight goes through the soles of their feet and the Plantar fascia reaches a tipping point where the amount of load it is put under exceeds the capacity that it can cope with. This is when pain results.

Age – As we get older, the quality of our Connective Tissue can deteriorate and this often results in our foot arches sagging or collapsing. This sagging makes Plantar Fasciitis more likely.

Symptoms

Symptoms are generally felt as an ache or sharpness on the inside aspect of the heel on the sole of the foot. The pain can sometimes spread forward and out towards the ball of the foot. These areas are usually also tender to the touch.

The pain is also at its worst for the first 15-30 minutes in the morning when getting out of bed and after exercise or prolonged walking. Typically, a person who is experiencing Plantar Fasciitiswill say that it feels like they are walking on broken glass particularly when they first get out of bed in the morning.

Diagnosis

At PhysioACTION we undertake a detailed assessment of how you stand and walk, particularly looking at their foot posture. We look at the foot to see if there is any swelling around the heel or the rest of the sole of the foot. We then assess how all the joints of their foot, ankle, knee & hip move. After that we look at muscle imbalances to see if this is causing any biomechanical issues. Then we prod the soft tissues to see how it feels, which areas are tender to touch, which areas feel thickened and so on.

Once we’ve put all these findings together, we can give our patient an accurate diagnosis of their injury as well as explaining to them the cause of these symptoms and what we need to do as well as giving approximate time scales for recovery.