Plantar Fasciitis

The plantar fascia is a tight band of fibrous connective tissue that originates at the heel and splits into five bands to insert at the toes. The plantar fascia is a shock absorber and helps create stability in the foot with walking and running activities. The ankle has two primary motions: plantar flexion and dorsiflexion. Plantar flexion is the movement caused when pushing your feet downwards, such as pressing on a gas pedal. Dorsiflexion is the opposite movement, such as pulling your foot up towards your body. During walking, the trailing foot must achieve dorsiflexion. Dorsiflexion causes tension on the plantar fascia, creating increased stability in the foot. This allows the plantar fascia to assist in sturdiness of the foot to advance each leg with walking.

Plantar fasciitis (commonly misdiagnosed as heel spurs) is a condition of micro-tears in the plantar fascia due to repetitive strain, or can occur as a result of trauma. Approximately one million patient visits per year are due to plantar fasciitis (2). Symptoms are often described as stabbing pain with the first steps of the morning, or after a long period of sitting. Plantar fasciitis is largely common in runners, basketball players, tennis players, dancers, overweight and diabetic patients, manual labor workers, those that wear shoes with inadequate support, and others (1,3,7). Athletes and non-athletes are both affected at the same percentage.

A podiatrist may refer a patient for imaging such as MRI, x-ray, and/or ultrasound for diagnosis. Podiatric treatment includes referral to physical therapy, using an orthotic and/or night splint, medication, or steroid injection. According to research, corticosteroid injections should be re-evaluated as they are associated with increased risk of plantar fascia rupture (4).

Physical therapy evaluation consists of a detailed subjective history, range of motion, strength, palpation, and special tests. Conservative management, such as physical therapy, is the initial step to treating plantar fasciitis. This includes stretching, endurance and strengthening exercises, joint mobilizations to improve ankle and great toe range of motion, dry needling, taping, heel inserts, night splints, relative rest, and patient education.  Luckily, non-surgical treatment is successful in 90% of patients (5). Patients who received dry needling for treatment of plantar fasciitis had lower pain levels after one year compared to patients who received a corticosteroid injection (7).

Another possible cause of planar fasciitis is over pronation. This can be caused from a collapse in one of the arches of your foot. Many people think of the foot’s arch as just the inside arch, or the “medial longitudinal arch.” However, your foot also has a “lateral longitudinal arch” and a “transverse arch.” The transverse arch can be especially difficulty because it does not have much muscular support for stability of the arch. For this reason, if there is an issue with the transverse arch, patients often benefit from a custom orthotic. These can be expensive, however, Dr. Imam at Dynamic Physio is able to make a temporary custom orthotic that will determine whether or not you will benefit from a long-term custom orthotic. If needed, we are able to write a script and refer you to an appropriate provider to build you a custom orthotic for a reasonable price. In the case of all failed conservative treatments, surgery is the last resort (2).

If you have foot pain and/or symptoms of plantar fasciitis, be sure to visit your local podiatrist and ask for a referral for physical therapy.

References

1.     "Analysis of Data on the Prevalence and Pharmacologic Treatment of Plantar Fasciitis Pain." National Center for Complimentary and Integrative Health, 27 Mar. 2018, www.nccih.nih.gov/research/research-results/analysis-of-data-on-the-prevalence-and-pharmacologic-treatment-of-plantar-fasciitis-pain#:~:text=Approximately%20one%20percent%20of%20U.S.,with%20pa.

2.     Buchanan BK, Kushner D. Plantar fasciitis.Available from:https://www.ncbi.nlm.nih.gov/books/NBK431073/ (last accessed 22.6.2020)

3.     DeMaio M, Paine R, Mangine R, Drez D. PLANTAR FASCIITIS. ORTHOPEDICS. 1993; 16: 1153-1163. doi: 10.3928/0147-7447-19931001-13 [link]

4.     Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Journal of the American Podiatric Medical Association. 2003 May;93(3):234-7.

5.     Neufeld, Steven K. MD; Cerrato, Rebecca MD Plantar Fasciitis: Evaluation and Treatment, Journal of the American Academy of Orthopaedic Surgeons: June 2008 - Volume 16 - Issue 6 - p 338-346

6.     "Plantar fasciitis.", Mayo Clinic, 11 Dec. 2019, www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846.

7.     Rastegar, S., Baradaran Mahdavi, S., Hoseinzadeh, B. et al. Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial. International Orthopaedics (SICOT) 42, 109–116 (2018). https://doi-org.proxy.lib.wayne.edu/10.1007/s00264-017-3681-1