EVIDENCED BASED MEDICINE Planter fasciitis
Planter fasciitis is the most common form of heal pain. Runners and athletes with plantar fasciitis may notice heel pain that gets progressively worse during a workout. Left untreated over weeks or months, the pain may become worse or more frequent, interrupting daily activities. In planter fasciitis fibrous connective tissue at the under surface of our foot becomes inflammed over time. It begins at the heel bone and widens as it spreads out across the bottom of the foot. The plantar fascia had the functional role of maintaining foot arch integrity and plays an important role in foot stability and biomechanics such as: 1) When the un-weighted foot is at rest, the ankle joint is in neutral and the plantar fascia is shortened.
2) When standing and the foot weighted, the plantar fascia is lengthened. 3) When walking or running, the foot strikes the ground and the arch of the foot flattens, stretching out the plantar fascia. It then rebounds, helping the foot push off the ground.
How do you get Plantar Fasciitis? During waking or running the plantar fascia stretches, think of it like a bow under the foot. During any soft tissue in the body repeated overuse can cause inflammation over time. Firstly, tiny tears or micro-tears develop in the plantar fascia. This then leads to irritation and then Inflammation of the plantar fascia. Inflammation and/or micro-tearing typically occur near where the plantar fascia attaches to the heel bone, which is why pain is felt in the heel. Here then tissue causes traction on the bone. If this is not treated soon, chronic inflammation can develop which makes the fascia weaker and prone to larger tearing, ultimately effecting the whole foot mechanics. People with plantar fasciitis often feel heel pain when getting out of bed. As a person sleeps, the ankles rest at 100 or 110 degree, allowing the plantar fascia to relax and shorten. Once the person stands, the ankles are at 90-degree angles and the plantar soft tissues are weighted and forced to stretch, which often causes pain.
Causes of planter fasciitis Excessive foot pronation
Normally, when the foot lands on the ground the arch somewhat drops (pronation). However, if one suffers from over probation this puts extra pressure on the inner foot, which can strain the plantar fascia. Weak ankle stabilising muscles Tight calfs Genetic predisposition
Conservative Treatment for planter fasciitis Initial treatments for plantar fasciitis do not involve injections or surgery. Patients can initiate some treatments, such as rest and stretching.
Rest. Patients are advised to cut back on running or other activities that keep them on their feet for an extended period of time.
Better footwear. More practical shoes with soft soles and arch supports will place less strain on the plantar fascia. For some athletes, just changing running shoes can significantly ease plantar fascia pain.
Taping and Acupuncture/Dry needling. Your osteopath can provide acupuncture and a number of different taping techniques to support the plantar fascia, giving it a chance to heal.
Orthotics. Some shoes can be fitted with corrective orthotics which can provide support and put less strain on the plantar fascia. Another option is a heel cup. This insert is designed to support and cushion the heel.
Stretching. Plantar fasciitis is associated with less flexibility in the ankle, Achilles tendon, and calf muscles. Gentle stretching to improve flexibility can make the biomechanics of standing, walking, and jogging less stressful for the plantar fascia. Shorter running strides. For runners, using a shorter stride may reduce the stress on the plantar fascia even though there will be more steps per minute.
Weight loss. Extra weight puts an increased strain on the plantar fascia tissue. Shedding excess pounds will lighten the load on the body’s musculoskeletal system, including the plantar fascia.
Night splints. These are worn at night and keep the ankle flexed at 90 degrees. This prevents the plantar fascia from resting in a contracted position. (Understandably, many people find these splints difficult to sleep in.)
Manipulation. While not all experts agree, some think the use of manual manipulation along with exercise is an effective way to treat plantar fasciitis.
If conservative treatment fails
Due to modern living, sometimes planer fasciitis can turn into chronic pain. if this is the case the other modes of treatment are also available. They are a few types of injections offered to treat plantar fasciitis that deliver good success. Steroid injections and PRP injections
Cortisone injections (steroid injection)
Plantar fasciitis suffers who are in moderate to severe pain and have not responded to treatment may be advised to have a cortisone injection. This steroid will reduce or eliminate inflammatory pain but may have an overall degenerative affect on the protective fatty pads at bottom of the foot. Although good for inflammation, cortisone injections can also weaken the plantar fascia, putting it at an increased risk for rupture (tear). Cortisone injections also carry a risk of fat pad atrophy resulting in chronic heel pain. Platelet rich plasma (PRP) injections
Growing in popularity, platelet rich plasma (PRP) treatment is a natural treatment commonly used in sports medicine that uses platelets from the patient’s blood to promote and facilitate healing in damaged tissue. Increased data from evidenced based clinical studies are increasingly showing that platelet rich plasma injections are safe and effective for the treatment of plantar fasciitis, (12,13,14,15).
CLIICK ON THE BELOW STUDIES TO SEE EVIDENCED BASED PRACTICE
(2016) Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo (Interesting read) PRP vs Steroids
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