The plantar fascia is a thick fibrous band that runs the length of the sole of the foot. The plantar fascia helps maintain the complex arch system of the foot and plays a role in one's balance and
the various phases of gait. Injury to this tissue, called plantar fasciitis, is one of the most disabling running injuries and also one of the most difficult to resolve. Plantar fasciitis represents
the fourth most common injury to the lower limb and represents 8 -10% of all presenting injuries to sports clinics (Ambrosius 1992, Nike 1989). Rehabilitation can be a long and frustrating process.
The use of preventative exercises and early recognition of danger signals are critical in the avoidance of this injury.
Plantar fasciitis most commonly occurs due to repetitive or prolonged activities placing strain on the plantar fascia. It is often seen in runners, or dancers and gymnasts who perform regular
activities involving end of range foot and ankle movements. It may also occur in patients who walk excessively, especially up hills or on uneven surfaces. Older patients who spend a lot of time on
their feet may also develop the condition. Plantar fasciitis frequently occurs in association with calf muscle tightness, inappropriate footwear, or biomechanical abnormalities, such as excessive
pronation (flat feet) or supination (high arches). Occasionally the condition may occur suddenly due to a high force going through the plantar fascia beyond what it can withstand. This may be due to
activities such as a sudden acceleration or a forceful jump.
People with this condition sometimes describe the feeling as a hot, sharp sensation in the heel. You usually notice the pain first thing in the morning when you stand. After walking for a period of
time, the pain usually lessens or even disappears. However, sharp pain in the center of the heel may return after resting for a period of time and then resuming activity.
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain
other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are
found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Non Surgical Treatment
If you protect your injured plantar fascia appropriately the injured tissues will heal. Inflammed structures will settle when protected from additional damage, which can help you avoid long-standing
degenerative changes. Plantar fasciitis may take from several weeks (through to many months) to heal while we await Mother Nature to form and mature the new scar tissue, which takes at least six
weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that may become lumpy or potentially re-tear in the future. It is important
to lengthen and orientate your healing scar tissue via massage, gentle stretches, and light active exercises. In most cases, your physiotherapist will identify stiff joints within your foot and ankle
complex that they will need to loosen to help you avoid plantar fascia overstress.A sign that you may have a stiff ankle joint can be a limited range of ankle bend during a squat manoeuvre. Your
physiotherapist will guide you.
Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The
most common complications of release surgery include incomplete relief of pain and nerve damage.
Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your
hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you
in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should
feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or