Plantar fasciitis is a common, painful foot condition. Patients, and sometimes doctors often confuse the terms plantar fasciitis and heel spurs. Plantar fasciitis refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot; a heel spur is a hook of bone that can form on the heel bone (calcaneus). About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on x-ray.
The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.
Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).
The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise.
Non Surgical Treatment
In mild cases patients would benefit from custom made semi rigid full length custom made foot orthoses fitted into appropriate supportive footwear, preferably with laces or a velcro straps. In more severe cases patients may require a custom made Arizona lace up ankle brace or a posterior shell Ankle Foot Orthosis. These offer significantly more control and support than the foot orthoses. In severe cases surgery may be required to repair the tibialis posterior tendon and realign the foot and ankle, or fuse the subtalar joint. It is important to note there are many risks involved in having surgery and these must be considered prior to going ahead.
Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience.
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.
Achilles stretch. Stand with the ball of one foot on a stair. Reach for the step below with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. Balance and reach exercises. Stand next to a chair with your injured leg farther from the chair. The chair will provide support if you need it. Stand on the foot of your injured leg and bend your knee slightly. Try to raise the arch of this foot while keeping your big toe on the floor. Keep your foot in this position. With the hand that is farther away from the chair, reach forward in front of you by bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15 times. To make the exercise more challenging, reach farther in front of you. Do 2 sets of 15. While keeping your arch raised, reach the hand that is farther away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 15. Towel pickup. With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Resisted ankle plantar flexion. Sit with your injured leg stretched out in front of you. Loop the tubing around the ball of your foot. Hold the ends of the tubing with both hands. Gently press the ball of your foot down and point your toes, stretching the tubing. Return to the starting position. Do 2 sets of 15. Resisted ankle dorsiflexion. Tie a knot in one end of the elastic tubing and shut the knot in a door. Tie a loop in the other end of the tubing and put the foot on your injured side through the loop so that the tubing goes around the top of the foot. Sit facing the door with your injured leg straight out in front of you. Move away from the door until there is tension in the tubing. Keeping your leg straight, pull the top of your foot toward your body, stretching the tubing. Slowly return to the starting position. Do 2 sets of 15. Heel raise. Stand behind a chair or counter with both feet flat on the floor. Using the chair or counter as a support, rise up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the support. (It's OK to keep holding onto the support if you need to.) When this exercise becomes less painful, try doing this exercise while you are standing on the injured leg only. Repeat 15 times. Do 2 sets of 15. Rest 30 seconds between sets.