Plantar Heel Pain Syndrome (Fasciitis) ( Fasciiosis)

Plantar Fasciitis is probably one of the most common Biomechanical condition seen in a Podiatrists rooms.

It is a condition that is poorly understood and managed by the medical fraternity as it often requires a multi-disciplinary approach to solve it completely.

It manifests as pain in the medial heel area, sometimes across the heel or the lateral side where the Plantar Fascia tendon attaches to the Calcaneus.

When one is non-weight bearing or resting, there is no pain, but as soon as one stands a sharp pain strikes in the heel that takes a while to subside as one gets going. Then as the day progresses the pain will return as aching tired feet.It is more common in middle aged people however it can manifest right across the spectrum of ages depending on the activity and the biomechanics.

It can occur in high arched or flat footed people, or in those whose arches are ‘dropping’. The mechanism involved is that the plantar fascia, just before heel lift off should be shortening as the foot re-establishes an arch for propulsion. If however the arch is not being re-established then there will be an overstretch of the plantar fascia. It will eventually start to tear from the Calcaneus.

Chronic Plantar Fasciitis may eventually lead to Heel Spur formation that shows up as a small bony outgrowth on the heel on X-Ray.

It is not the Spur that causes the pain, and this is important, as some medical practitioners may be voting to remove the spur. This is not recommended, as it does not deal with the fundamental biomechanics of the foot. Surgical removal often ends up in other complications arising in the foot as a consequence of the release of the Plantar Fascia. This is not to say that there is no success, it means that there is a risk of failure in the technique.

There are many steps that can be taken in dealing with this condition. It needs to be established as to the severity of the condition and one could use the pain scale that measures pain from 0-10. This is a judgement that is made by the patient on his condition.

Then one needs to identify the cause. The Podiatrist will do a Biomechanical assessment to establish the faults that exist in foot function and the reasons why the foot is stressing the Plantar Fasciia.

Flexibility of the calf muscles is often an issue and the appropriate stretching exercises need to be done. Structural fault need to be improved with appropriate footwear, insoles or orthotics. Moulded orthotics are custom supports that assist the foot in restoring the timing in function, reducing the over-stretch of the Fasciia.

Pain management with Anti-Inflammatories to assist in initial discomfort. Topical applications can be used to bypass the need for oral medication.

Home self-help Physiotherapy can be applied through massage, hot and cold foot baths. Or a Physiotherapist can assist recovery. I find that once biomechanics have been dealt with the Physiotherapist has better results in healing the condition.
Cortisone injections are an option, although the area is poorly vascularised and in the long run this could lead to degeneration of the tendon. They can however relieve pain, and a series of injections can in some cases even solve the problem. In my experience though, if the biomechanical faults are still in place, the condition can recur.

Surgery is a very last option for those that have not responded to conservative therapy. There are various choices open to the surgeons to dealing with the Plantar Fasciia. It can be a release of the Fasciia, or a scraping of the scar, fibrous tissue. The technique used will depend on the symptoms presented.

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