What is the Plantar Fascia?
The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.
It provides key functions during running and walking. In general, the purpose of the plantar fascia is twofold – to provide support of the longitudinal arch and to serve as a dynamic shock absorber for the foot and entire leg. the purpose of the plantar fascia is twofold – to provide support of the longitudinal arch and to serve as a dynamic shock absorber for the foot and entire leg.
As one walks, the heel makes contact with the ground. Just after this contact, the tibia (calf bone) turns inward and the foot pronates, stretching the plantar fascia and flattening the arch. This allows the foot to accommodate for irregularities in the walking surface and absorb shock.
Plantar fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin on the calcaneus (heel bone). It is the most common cause of inferior heel pain, and its symptoms may have a dramatic impact on physical mobility.
The word ‘fasciitis’ assumes inflammation is an inherent component of this condition. However, recent research has suggested that some presentations of PF manifest non-inflammatory, degenerative processes.
Pathophysiology of PF
In the presence of aggravating factors, the repetitive movement of walking or running can cause micro-tears in the plantar fascia. The affected site is frequently near the origin of the plantar fascia at the medial tuberosity of the calcaneus (heel bone).
In athletes, PF appears to be associated with overuse, training errors, training on unyielding surfaces and improper or excessively worn footwear. Sudden increases in weight-bearing activity, particularly those involving running, can also cause micro-trauma to the plantar fascia at a rate that exceeds the body’s ability to recover.
When PF occurs in elderly adults, it is often attributable to poor intrinsic muscle strength and poor force attenuation, secondary to acquired pes planus (excessive pronation of the foot – see previous blog) and compounded by a decrease in healing capacity.
Interestingly, individuals with diabetes mellitus may suffer from PF as a result of peripheral motor neuropathy leading to muscle atrophy, changes in anatomical structure of the feet (claw toes, pes cavus or high arches, prominent metatarsal heads etc), and functional alterations in gait.
Common Risk Factors for PF
· Obesity or sudden weight gain;
· Reduced ankle dorsiflexion;
· Excessive pronation (pes planus);
· Heel spurs.
Initially, for symptom relief:
· Avoidance of aggravating factors.
Treatment and rehabilitation to reduce the chances of persistent pain and injury recurrence should include:
· Cross-friction massage above the PF;
· Achilles tendon stretching;
· Specific calf isolated muscle stretching;
· Strengthening of the intrinsic muscles of the foot.
Extrinsic considerations during rehabilitation should include:
· Shoes with adequate arch support;
· Training technique;
· Training surfaces;
At Function360 we aim to identify the cause of Plantar Fasciitis, be it biomechanical or technical. Once symptoms are diminished, through specific treatment and advice, we work to address each contributing factor. Our priorities are to achieve full recovery, speed up the individuals return to their sports and/or recreational activities and limit the chances of injury recurrence.