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  • Writer's pictureAgnieszka Kosinska

Plantar Fasciitis

Are you experiencing pain in your heel or in the arch of your foot?

You may be suffering from a condition called plantar fasciitis sometimes referred to as inflammation of the arch tendon or heel spur.



It is a common foot problem. It starts as a dull intermittent pain in the heel which may progress to a sharp persistent pain. It is usually worse in the morning with the first few steps, or after sitting for a period of time and then standing up.


Anatomy


The foot is an intricate part of the body, consisting of 26 bones, 33 joints, 107 ligaments, and 19 muscles. The 26 bones in the feet make up ¼ of the bones in your entire body. The same goes for your muscles – ¼ of all the muscles and motor nerves in your body are dedicated to your feet.



Plantar Fasciitis is caused by inflammation of the connective tissue in the base of the foot. This connective tissue is known as the plantar fascia.

One of its main roles is to keep the bones and joints in position and enables us to push off from the ground. Bruising or overstretching this ligament can cause inflammation and heel pain. In many cases, plantar fasciitis is associated with a heel spur. Surprisingly, the spur itself does not cause pain, and may often be found in the other foot without symptoms.

Every day, all these complex structures carry your weight every step you take, jump or run.


What causes plantar fasciitis?


One of the main reasons why we have problem with our feet and plantar fascia ligament is because of the crazy choices we make in footwear, our feet have become pathologically weak.

Feet and humans grew up together and evolved together for hundreds of thousands of years before any shoes showed up on the scene. Over a years footwear gradually evolved from light surface protection to completely engineered full-body stabilizers like the hiking boot or fashion shoes. Regardless of the type of shoe you wear, one thing is certain. Shoes cut your feet off from the world. When a layer of rubber is between your foot and the ground, the nerve endings that provide the brain with proprioceptive feedback and copious amounts of information are being cut off.

Now imagine that when you were two years old, someone placed stiff, tight, leather mittens over your hands, lumping all of the bones together, every day from morning to night. Your body would adapt to the situation and find a way to work around the awkwardness of it but your hands would lose most of their sensitivity, and the brain would be deprived of feedback from your normal day-to-day activities. The act of wearing modern footwear every day has created a mitten-hand situation in your feet. We have weak, underdeveloped muscles within the foot and have placed large loads on the muscles of the lower leg, on the joints in the foot and on passive tissues (those that cannot adapt strength) like the facial systems and ligaments of the foot. In addition, foot problems can translate into ankle, knee, hip and low back pain.


Once we developed weak feet the plantar fasciitis is caused by excess pulling and strain on the plantar fascia ligament. Excess strain on this ligament happens for various reasons:

  • Over-pronation, flat feet or high arches. People with flat feet may have reduced shock absorption, increasing strain on the plantar fascia. High arched feet have tighter plantar tissue, leading to similar effects.

  • Overweight. Weight places a greater mechanical load on the plantar fascia. There is evidence that overweight and inactivity lead to chemical damage to the plantar fascia, with a worsening of pain.

  • Pregnancy. Weight gain, swelling and hormonal changes that accompany pregnancy may lead to mechanical overload of the plantar fascia.

  • Work that requires standing on hard floors and/or for long periods of time

  • Wearing poorly designed shoes may contribute to problems. With poor arch support, stiff soles or high heeled shoes.

Treatment


The good news is that, as long as your feet contain living tissue, they can change, grow and improve no matter what they’ve been doing ( or not doing ) up to this point.

Plantar fasciitis is reversible and successfully treated – about 90% of people with plantar fasciitis improve significantly within two - three months. The most common treatment methods include:

  • Ice – applied onto the heel area for around five minutes

  • Rest or reduced activity – refraining from standing for long periods, walking, running, sports

  • Orthotic insoles – to correct poor foot biomechanics

  • Physiotherapy – program of daily exercises can help stretch the plantar facia and to strengthen lower leg muscles to improve the range of movement, reduce pain, and support healing

  • Massage therapy or self- golf ball massage can help by reducing both pain and inflammation

  • Cortisone-steroid injections – into the heel bone


Exercises


Calf stretch

  • Stand facing a wall with your hands on the wall at about shoulders level. Put the leg you want to stretch about a step behind your other leg

  • Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg

Hold for 30 seconds, repeat 4-5 times each leg.



Towel stretch


Sit with involved leg straight out in front of you. Place a towel around your foot and gently pull toward you, feeling a stretch in your calf muscle

Hold for 30 seconds, repeat 4-5 times each leg


Shin stretch


Stand up. You may want to use a hand on a wall or other support for balance.

  • Bend both knees slightly

  • One foot remains squarely on the ground. The foot to be stretched is placed just behind this stable foot, with the toe of the stretching foot touching the ground

  • Keeping your toe firmly on the ground, pull the stretching leg forward so you feel a stretch from the top of your stretching foot through your shins

Hold for 15-30 sec. repeat 4-5 times each leg


Lift the toes


Place your feet flat on the floor and try to lift each toe one by one. This may be difficult at first but try and lift each toe multiple times in a row at least once a day. This is an effective exercise for making the toes stronger and more flexible. Repeat 5 times



Toe spread


Rest the heels on the floor. Curl the toes tight, then lift and spread the toes apart as much as you can.

Hold this position for 10 seconds, repeat 5 times.

 

Retraining the muscles can increase the regeneration of the tissues that make up foot, which can decrease disease and increase the overall health of your feet.



References:

1. Joshua Kirkpatrick, Omid Yassaie, Seyed Ali Mirjalili: The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations; Journal of Anatomy 2017 Jun; 230(6): 743–751

2. Suthasinee Thong-On, MSc,Sunee Bovonsunthonchai, PhD, Roongtiwa Vachalathiti, PhD, Warinda Intiravoranont, BSc, Sarawut Suwannarat, BSc, Richard Smith, PhD: Effects of Strengthening and Stretching Exercises on the Temporospatial Gait Parameters in Patients With Plantar Fasciitis: A Randomized Controlled Trial; Annals of Rehabilitation Medicine 2019 Dec; 43(6): 662–676

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