Definition :
Plantar Fasciitis or the plantar fascia is a broad band of connective tissue that supports the medial longitudinal arch of the foot (1). It is a common cause of heel pain in adults, it is thought to be caused by biomechanical overuse from prolonged standing or excessive running, thus creating microtears at the calcaneal enthesis. (2), PF is also referred to as plantar heel pain syndrome, heel spur syndrome, plantar fasciopathy or painful heel syndrome. Generally, the pain presents on first walking in the morning or after a rest period, but it can also occur after extensive walking, standing or have been seated for a prolonged time. In athletes, the pain can appear after a period of intense training, normally declines with the warm-up and reappears at the end of the training session, Foot stiffness and heel swelling are also present. Patients that complain of posterior heel pain are more likely to suffer from Achilles pathology, retro-calcaneal bursitis, Haglund deformity, or compensatory pain due to tightness of the calf muscles. Plantar heel pain could also occur from a bruise to the fat pad or calcaneal heel spur. Risk factors: The risk factors associated with the onset of plantar fasciitis are Intrinsic (to do with body characteristics) & Extrinsic which are external to the body that causes injury(3).
Intrinsic:
a)- Anatomical Risk: Overpronation, Overweight, Leg length discrepancy.
b)- Functional Risk: Gastrocnemius & Soleus tightness, Achilles tendon tightness, Calf muscles weakness.
C)- Degenerative Risk: Plantar fascia stiffness, Aging of the heel fat pad.
Extrinsic:
a)- Overuse: Mechanical stress, Micro tearing.
b)- Incorrect training: Fast increase in distance/duration/intensity or activity that involves repetitive impact loading on feet.
C)- Inadequate footwear: Poorly cushioned surface, Inappropriate replacement of shoes.
How to manage PF:
Non-operative management could include pain management e.g., NSAIDs, habit modification(rest or protected weight-bearing), K- taping, wear modification e.g. (orthosis), use of night splint, and physiotherapy (specific stretching protocols for the plantar fascia & Achilles tendon will be discussed later on), Shockwave therapy, Corticosteroid injections may be considered if symptoms persist after 4 weeks.
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References:
1-Goff, J.D. and Crawford, R., 2011. Diagnosis and treatment of plantar fasciitis. American family physician, 84(6), pp.676-682.
2-Stuber, K. and Kristmanson, K., 2006. Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials. The Journal of the Canadian Chiropractic Association, 50(2), p.118.