Plantar Fasciitis (Heel Pain)
Inflammation at the origin of the plantar fascia. Over-stretching of the fascia leads to excess traction and inflammation. The development of scar tissue makes the fascia less flexible and causes further traction from other parts of the foot.
The patient presents with a dull to sharp pain occurring about the medial plantar calcaneal area when arising from rest and continuing during the initial periods of weight bearing. The pain is more severe in the morning when getting out of bed as the plantar fascia is more inflexible at those times.
Excess subtalar joint pronation lowers the arch structure, elongates the foot and places a tractional force on the plantar fascia. Over time, these tractional forces result in inflammation of the fascia and surrounding tissues, causing pain in the arch and heel. This may lead to the development of a bony growth on the calcaneal tuberosity – referred to as a ‘heel spur’ – causing a sharp pain right in the centre of the heel. Tight calf muscles can add to plantar fascial pain if the foot cannot dorsiflex at the level of the ankle during the propulsive phase of gait. This results in the foot dorsiflexing at the midtarsal joint which in turn places extra strain on the plantar fascia.
Biomechanical plantar fasciitis is best treated mechanically by correcting abnormal foot mechanics. Orthotics designed to control excess subtalar joint pronation will, via the Windlass mechanism, assist the arch in rising and plantar fascial tension will be reduced. Surgery is seldom required and should be avoided whenever possible.
Ice therapy (20 minutes, several times per day), anti inflammatory drugs, electro-therapeutic modalities, night splint.
Plantar fascia stretch, Toes raises, Calf muscles stretch.