Plantar Fasciitis
SOME MEDICAL FACTS
Description Plantar Fasciitis & Heel Spur:
Plantar Fasciitis is an inflammation of or a tear at the point of contact of one or more of three thick bands of muscle and tendon tissue (plantar fascia) that run across the bottom of your foot and connects your heel bone to the forefoot and toes. The “Plantar Fascia” in conjunction with the “Flexor Digitorum Brevis” anchor your heel, and toes. This layered web of muscle and tendons in each foot act as a spring during each step. As your weight is transferred from your heel to the ball of your foot the web stretches and then rebounds. This assists your foot to toe off giving you forward motion.
Heel Spurs are the second and the more painful stage of Plantar Fasciitis. Heel Spurs are formed as a direct result of the body trying to heal itself. A heel spur is a build up of deposits of calcium at the points on the heel bone where the Plantar Fascia have torn or partially detached and become inflamed. The pointy deposits of calcium are like nails tearing at the muscle and tendon at the attachment point. The pain can be and is most often agonizing and debilitating. Your first steps in the morning can force you to wince in pain and limp to your bathroom. The onset of pain is gradual and grows in intensity over a period of time.
Cause:
Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, inflammation of the plantar fascia, and repeated tearing of the membrane that covers the heel bone; heel spurs are “most” often associated with Plantar Fasciitis. Inflammation caused by Plantar Fasciitis can cause calcium to deposit on the heel bone at the connection point of the plantar fascia ligaments. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.
Risk factors for heel spurs include:
- Walking gait abnormalities,which place excessive stress on the heel bone, ligaments, and nerves near the heel
- Running or jogging, especially on hard surfaces
- Poorly fitted or badly worn shoes, especially those lacking appropriate arch support
- Excess weight and obesity
Other risk factors associated with plantar fasciitis include:
- Increasing age, which decreases plantar fascia flexibility and thins the heel’s protective fat pad
- Diabetes
- Spending most of the day on one’s feet
- Frequent short bursts of physical activity
- Having either flat feet or high arches
Symptoms:
Diagnosis:
Heel spurs are diagnosed with ultrasound or X-ray imaging of the foot to identify the bony prominence (spur) of the heel bone (calcaneus). If the spur is symptomatic, identifying the underlying diagnosis such as plantar fasciitis, Achilles tendonosis, or a systemic arthritis is required in order to treat appropriately.
Pathophysiology:
The specialized soft tissue at the heel functions as a shock absorber. The subcutaneous structure consists of fibrous lamellae arranged in a complex whorl containing adipose tissues that attach with vertical fibers to the dermis and the plantar aponeurosis.
The heel can absorb 110% of the body’s weight during walking and 200% of the body’s weight during running. The plantar fascia is a multilayered fibroaponeurotic structure that arises predominantly from the medial calcaneal tuberosity and inserts distally through several slips into the plantar plates of the metatarsophalangeal joints, the flexor tendon sheaths, and the bases of the proximal phalanges of the toes.
Dorsiflexion of the toes applies traction stress at the origin of the plantar fascia. A contracture in the triceps surae, a pes cavus, or a pes planus can increase the traction load at the origin of the plantar fascia during weight bearing activities.
Other anatomic factors that can have similar effects are overpronation, discrepancy in leg length, excessive lateral tibial torsion, and excessive femoral anteversion. However, overuse, not anatomy, is the most common cause of plantar fasciitis in athletes. The pain of plantar fasciitis is caused by collagen degeneration associated with repetitive microtrauma to the plantar fascia
An inflammatory response and reparative process can double the thickness of the plantar fascia, which is normally approximately 3 mm. Biopsy specimens reveal collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and calcification.
The heel pain can also have a neurologic basis. The tibial nerve, with nerve roots from L4-5 and S2-4, courses in the medial aspect of the hindfoot, through the tarsal tunnel, under the flexor retinaculum, and over the medial surface of the calcaneus. The calcaneal branch, arising directly from the tibial nerve, carries sensation from the medial and plantar heel dermis.
The tibial nerve divides into lateral and medial plantar nerves, which proceed into the plantar aspect of the foot through a foramen within the origin of the abductor hallucis muscles, which forms the distal tarsal tunnel. The first branch of the lateral plantar nerve changes course from a vertical to a horizontal direction around the medial plantar heel. It passes deep to the abductor hallucis muscle fascia and the plantar fascia and is the nerve supply to the abductor digiti minimi. The tibial nerve and its branches in the hindfoot can be involved with compressive neuropathies. A valgus heel can stretch in the tibial nerve.
OPTION ONE
A 2ft custom made Orthotic puts an end to your foot pain caused by this painful condition. Conservative care is highly successful in the cavus high arch foot. An orthotic with a high lateral heel flange, a valgus post and a sub-first metatarsal cutout can balance the foot. Often, the first ray is plantarflexed and a cutout of the first metatarsal head is essential for forefoot balancing. In severe ankle instability cases, an over the counter ankle-foot orthotic or a custom ankle-foot orthotic can be beneficial in balancing the foot and ankle. Consideration of a first ray cutout should also be part of the bracing process.
Our promise is; no drugs, no pricey consultation fees, no more pain and it’s backed by the 2ft 100% Comfort Guarantee.
Your custom made 2ft Orthotic supports all three of your foot arches not just one. It is designed to realign the ankle joint so the centers of gravity correctly transfer the compression forces of your body down to the ground correctly. This ensures that your standing stance and walking gait normalize and work as designed. The inbuilt torsion & compression bars take the strain off of the Plantar Fascia and assist in putting a spring back intro your every step making it easier to walk and run. Our Orthotic is a marvel of engineering and it can significantly change your life. Try it on and you will never look back.
OPTION TWO
Ultrasound Therapy
While ultrasound therapy is a great treatment method to relieve heel pain, it is not a permanent solution. Regular treatments are often necessary to prevent the heel pain from reappearing. For many people, ultrasound therapy is an effective form of treatment for heel pain. It sends sound waves to the injured, painful area. These waves move at a frequency of one million vibrations per second. They can penetrate over 2 inches into the body providing the targeted relief you are looking for.
Main Disadvantage
While ultrasound therapy is a great treatment method to relieve heel pain, it is not a permanent solution. Regular treatments are often necessary to prevent the heel pain from reappearing.
OPTION THREE
Prolotherapy
Prolotherapy, also called proliferation therapy is an injection-based treatment used in chronic musculoskeletal conditions. It has been characterised as an alternative medicine practice.
Prolotherapy (Proliferative Therapy), also know as Non-Surgical Ligament and Tendon Reconstruction and Regenerative Joint Injection, is a recognized orthopedic procedure that stimulates the body’s healing processes to strengthen and repair injured and painful joints and connective tissue. It is based on the fact that when ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new collagen tissue, resulting in permanent stabilization of the joint. Once the joint is stabilized, pain usually resolves. Traditional approaches with surgery have more risk and may fail to stabilize the joint and relieve pain, and anti-inflammatory or other pain relievers only act temporarily. The original term used for this therapy was “sclerotherapy”, coined in the 1930’s when this treatment was discovered, and included both joint and vein injections. Today the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.
OPTION FOUR
Invasive Surgery
Surgery: “Not Recommended”
Infrequently, surgery is performed on chronically inflamed spurs or Plantar Fascia. More recent treatments include radio frequency ablation, injections of platelet rich plasma (PRP), extra-corporal shock wave therapy (ESWT), prolotherapy injection, and ultrasonic micro debridement.
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