The calcaneal tuberosity of the heel, the surrounding perifascial tissues, and the plantar fascia at its origin all exhibit collagen degeneration, which leads to plantar fasciitis.
The plantar fascia is crucial in supporting the arch and absorbing shock, and it also plays a significant part in the correct biomechanics of the foot. This illness has "itis," but is distinguished by the lack of inflammatory pathology. As a result, the terms "fasciosis" and "fasciopathy" are used more frequently to describe this disorder.
The condition is characterized by medial heel discomfort that gets worse after resting or not carrying any weight. Symptoms of plantar fasciitis frequently develop continuously and last for more than a year.
Mostly due to repetitive strain generating micro-tears of the plantar fascia, but can also occur as a result of trauma or other multifactorial reasons, frequently manifests as an overuse injury.
There are many risk factors for plantar heel pain including but not limited to:
- Increased plantar flexion range is inversely correlated withdecreased dorsiflexion and first metatarsophalangeal joint extension.
- Pes planus and pes cavus deformities
- Significant dynamic foot pronation
- Activities with impact or weight-bearing such as jogging, standing up for a long time, etc.
- Poorly fitting shoes
- Increased BMI
- BMI is not linked to an increased risk of plantar fasciitis in the population of athletes, but there is evidence that it is linked to an increased risk in the non-athletic population. There is some evidence to suggest that losing weight may lessen foot pain.
- Sub calcaneal spur present
- Leg length inequality;
- Diabetes mellitus;
- Other metabolic conditions
- Gastrocnemius, soleus, tendoachilles tendon, and intrinsic muscles that are tight or weak. A link between weight-bearing activities and plantar fasciitis is suggested by low-quality research.
- Accounts for 15% of all foot injuries in the general population and is most common in those between the ages of 40 and 60.
- About 17.4% of injuries related to running are more common among runners.
- Females are slightly more likely than males to present with plantar fasciitis.
Clinical testing can identify plantar fasciitis. The physical examination and patient history form the basis of it.
- Patients may experience pain after taking their initial steps or after exercising, as well as localized point tenderness along the anteromedial of the calcaneum.
- When the patient's pedal phalanges dorsiflex, further stretching the plantar fascia, plantar fasciitis discomfort is most noticeable. Therefore, any action that would lengthen the plantar fascia, such as toe walking, climbing stairs, or wearing shoes without an arch support, could make the pain worse.
- Imaging techniques like radiography, diagnostic ultrasounds, and MRIs may be employed by the physician.
- Reproduced by pressing on the plantar medial calcaneal tubercle on the heel bone, which is where the plantar fascia attaches.
- Passive dorsiflexion of the foot and toes causes pain to be recreated.
- Windlass Test: First metatarsophalangeal joint passive dorsiflexion (rest to cause symptoms at the plantar fascia by establishing maximum stretch); test is positive if the pain is replicated.
- Pes planus, pes cavus, and a tight Achilles heel cord are examples of secondary findings.
- Modified gait (examine for biomechanical issues that could put the client at risk for plantar fasciitis)
- Weight bearing at work.
- Anterior medial heel tenderness, limited dorsiflexion, and a tight Achilles tendon are all symptoms of heel discomfort that might occur with the first steps in the morning or after extended periods of not bearing weight.
- The preference for toe walking may be present or there may be a limp.
- Pain is typically exacerbated by walking barefoot on hard surfaces and climbing stairs.
- Many individuals might have suddenly increased their exercise level before experiencing symptoms.
The most common imaging method for this issue is ultrasonography, and plantar fascia thickness is frequently measured.
The initial preference is for conservative measures:
- According to the level of pain, a relative rest from the aggravating activity should be advised.
- NSAIDs used topically or orally can be used to treat discomfort after physical activity.
- A deep friction massage of the insertion and arch.
- In addition to the aforementioned treatments, night splints and shoe inserts or orthotics may be recommended.
- Inform patients about how to properly stretch and rehab the gastrocnemius, soleus, Achilles’ tendon, and plantar fascia.
If conservative approaches are not effective in relieving the pain:
- Corticosteroid injections
- Platelet-Rich Plasma (PRP)
- Endoscopic Plantar Fasciotomy
Physical Therapy Management
Patient education is a significant tool:
Based on the data that is currently available, the Clinical Practice Guidelines offer suggested physical therapy interventions. The most frequently advised interventions include manual treatment, stretching, taping, foot orthoses, and sleep splints.
- Mobilization of soft tissues and joints should be a part of manual therapy.Pain can be diminished with the use of myofascial release.
- The gastrocnemius/Soleus complex and plantar fascia should both be To stretch the plantar fascia, the patient crosses the injured leg over the non-affected leg and presses into the toe extension with the fingers across the base of the toes until a stretch is felt along the plantar fascia. Standing while stretching the Achilles tendon involves positioning the injured leg behind the contralateral leg with the toes pointing forward. After that, the front knee is bent while the back knee remains straight and the heel remains on the floor. Then, for a greater soleus stretch, the rear knee could be flexed.
- Pronation should be avoided by taping. The most popular taping method, lowdye, can reduce discomfort temporarily, but there isn'tenough research to say how long it will last. Stretching by itself may not be as effective as combining stretching and taping. There are both prefabricated and custom foot orthoses. Both the medial longitudinal arch and the heel must be supported and cushioned.
The Clinical Practice Guidelines state that dry needling, electrotherapy, and ultrasound cannot be suggested. There is some evidence in favor of low-level laser therapy, ketoprofen gel phonophoresis, changing your shoes, losing weight, therapeutic exercise, and neuromuscular re-education.
- Shoes with a rocker bottom should be worn as footwear.
- The patient should be directed to a more qualified healthcare physician for nutritional guidance if weight is a concern.
- The goal of therapeutic exercise and neuromuscular re-education should aim to lessen pronation and enhance weight-bearing weight distribution.
High-load strength training appears to be successful in the treatment of plantar fasciitis, much as tendinopathy treatments. Strength exercise with a high load may help to enhance function and hasten pain relief. According to the systematic review, there is not enough evidence to recommend foot muscle training for those with plantar fasciitis.