Posts Tagged ‘Plantar’
Plantar Fasciitis is the most common foot complaint and the main cause of heel pain, heel spurs and also arch pain. Millions of people suffer from Plantar Fasciitis, especially the over 50’s. Fortunately for 80-90% of Plantar Fasciitis sufferers there are some very effective treatment solutions available.
Definition:
Plantar Fasciitis (pronounced “plantar fash-eee-eye-tiss”) means litterally “inflammation of the plantar fascia”. Plantar Fasciitis is also called “Policeman’s Heel”. Plantar Fasciitis is often associated with calcaneal spurs (heel spurs).
Symptoms:
Plantar Fasciitis usually presents itself as a sharp pain, experienced at the underside or front of the heel bone. Often the pain is worse with your first steps when getting out of bed in the morning. For most people Plantar Fasciitis pain is more severe following periods of inactivity or rest, when getting up. After a short while the sharp pain subsides, turning into a dull ache. In the morning, stiffness and swelling in the heel area may be present.
The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You’re more likely to feel this after (not during) exercise and walking. Most people will put up with heel pain for at least 6 weeks before seeking (self)treatment, information and/or advice.
If Plantar Fasciitis is left untreated, it may become a chronic condition and treatment will become far more difficult. Also, Plantar Fasciitis sufferers tend to avoid putting weight on the sore heel and will try to walk on the forefoot in order to avoid pressure on the heel. With this abnormal walking pattern one could easily develop problems in the knees, hips or back.
Anatomy:
The Plantar Fascia is a thick, fibrous band of connective tissue that runs from the heel bone (calcaneus) along the sole of the foot like a fan, being attached at its other end to the base of each of the toes. It is a tough and resilient ligament structure that performs a critical function during walking and running.
The Plantar Fascia acts as a ‘bowstring’ connecting the ball of the foot to the heel. It forms the longitudinal arch of the foot and helps to lift the heel off the ground to prepare the foot for the ‘take-off’ (propulsive) phase of the gait cycle. During walking, at the moment the heel begins to lift off the ground, the Plantar Fascia endures tension that is around twice our body weight. The Plantar Fascia also act as a natural shock-absorber during walking and running.
Causes of Plantar Fasciitis:
Plantar Fasciitis is Latin for inflammation of the Plantar Fascia. This inflammation occurs at the point where the fascia attaches to the calcaneus (also known as the heel bone).
So what causes the Plantar Fascia to become inflamed? There are a number of various reasons for this to occur. For example, you are more likely to develop Plantar Fasciitis, if you are over 50 years old, if you’re overweight, or pregnant, or if you have a job that requires a lot of walking or standing on hard surfaces. You’re also at risk if you do a lot of walking or running for exercise (overuse injury). And if you have tight calf muscles (which a lot of people have) you’re also more likely to develop Plantar Fasciitis.
Research has shown, however, that the number 1. cause for Plantar Fasciitis is over-pronation (or fallen arches).
Over-pronation of the feet is very common, at least half of the population has this problem, but most people don’t realise they have this condition! Over-pronation simply means that the feet and ankles roll inwards too much during walking and that the arches collapse. With age, most people tend to over-pronate. However, this condition is not uncommon in children and teenagers, as well as athletes.
When the arch collapses the two outside points of the bow (being the heel and ball of the foot) are being placed farther away from each other. This puts repetitive stress on the Plantar Fascia. The attachment of the fascia into the heel bone is a tiny area of tissue, compared to the wide attachment area to the toes. Therefore, the constant excess pulling on the fascia will do damage to the weakest attachment point.
Over time irritation occurs at the heel bone, followed by inflammation and micro-tearing of the plantar fascia tissue. Sometimes swelling is present. If the pulling continues the heel bone will ‘respond’ and a bony growth will develop on the front of the heel bone. This is referred to as a ‘heel spur’. Interestingly, the heel spur itself doesn’t cause any pain, but the inflamed tissue around it does.
Plantar Fasciitis Treatment options:
Fortunately, most cases of Plantar Fasciitis can be treated effectively at home. Firstly, you need to refrain from activities that cause pain such as long walks, running, sports and standing for long periods. Rest allows any swelling, inflammation and/or pain to subside.
Applying ice (or a heat pack) to the heel area and using anti-inflammatory pain killers like Advil or Nurofen (both contain ibuprofen) will provide immediate pain relief.
However, long term, effective treatment of Plantar Fasciitis consists of a simple program of daily stretching exercises, combined with wearing an orthotic to support the arches.
Gentle stretching of the Plantar Fascia, the Achilles tendon and the calf muscles will all help making your feet and a lot more flexible, which in turn will help reduce the exessive pulling of the Plantar Fascia. Do the stretches fist thing in the morning and avoid walking barefoot on hard floors and tiles. Instead, slip on a pair of shoes with an orthotic inside them. Repeat the exercises (especially the calf stretches) a few times during the day.
You can find the complete Plantar Fasciitis stretching exercise program here. Or talk to your physiotherapist or podiatrist about specific exercises. Sometimes practitioners will prescribe a night splint, designed to gently stretch the fascia during the night.
With the combination of daily exercises and orthotics you will see a major improvement within a few weeks. If you are overweight, it is recommended to lose some weight as this will reduce the strain on your feet.
In cases where the pain persists, or is severe, Plantar Fasciitis can be treated with a cortisone-steroid injection into the heel. However, this is only a short term fix and the pain will return within 3 months. A newer treatment for Plantar Fasciitis (instituted prior to surgery) is electrocorporeal shock wave therapy. In this procedure, an instrument administers pulses of energy (shock waves) to your heel to relieve pain.
Surgery for Plantar Fasciitis is rarely required, unless all other treatments have failed to relieve the pain. Surgical procedures include removing a portion of the Plantar Fascia.
Plantar Fasciitis and Orthotics:
Research in America, Europe and Australia has clearly proven that wearing an orthotic insole is the best way to treat Plantar Fasciitis, especially when combined with daily exercises. However, it must be noted that this treatment regime is mostly effective for people who have started to notice heel pain recently (i.e. no longer than 6-8 weeks ago)l or for people who only suffer mild Plantar Fasciitis pain.
The reason an orthotic works is simple: the cause of Plantar Fasciitis is the constant pulling of the “bowstring” under the foot, because of the lowering of the arches. Orthotics prop the arches back up, thereby reducing the excessive tension on the plantar fascia.
With less tension on the plantar fascia, the damage to ligament can be reversed. The tissue is allowed to heal faster and repair the micro-tearing, which has occurred at the heel bone attachment.
There are different types of orthotics, including custom-made ones from a Podiatrist. However, not everyone will need a custom-made device. Nowadays, good supportive and inexpensive orthotics are available from retailers and specialty websites. The main factor is support, more so than cushioning. So don’t buy a soft, spongy or gel footbed, but rather an insole with a high arch, made of reasonably firm materials.
Tips for preventing Plantar Fasciitis:
Correcting some of the pre-disposing factors will ensure Plantar Fasciitis doesn’t re-occur, for example:
1. maintain a healthy weight: loose some weight, as this will reduce the physical load placed on the Plantar Fascia during walking
2. wear good quality, supportive shoes: i.e. shoes with a strong heel counter and with good flexibility in the front of the shoe (that allows the toes to bend back easily and naturally). A good shoe will help stabilise the heel and ankle joints during walking and running.
Don’t wear completely flat shoes. A raised heel reduces the tension in the plantar fascia.
3. try to avoid walking barefoot on hard surfaces (including hard sand on the beach)
4. always stretch your calf muscles before exercising (walking, running or sports) first. Greater flexibility in the tissue makes them less susceptible to damage.
The most common cause of heel pain and heel spurs is a condition called Plantar Fasciitis (sometimes misspelled Planter Fascitis). This is Latin for inflammation of the Plantar Fascia. The Plantar Fascia is the broad band of fibrous tissue that runs under the foot and that forms your arch. Because of a number of different factors the plantar fascia are being overly stretched and this continuous pulling results in inflammation and pain at the heel, at the point where the ligaments insert into the heel bone.
Over-pronation of the feet (fallen arches + rolling inward of the feet and ankles), tight calf muscles, as well as ageing and being overweight are the main causes for the plantar fascia being overly stretched. There are many ways to treat Plantar Fasciitis, including cortisone injections and surgery. However, in most cases heel pain relief can be achieved through self-help by following a number of easy, simple steps, most of which are aimed at reducing the pulling of the plantar fascia.
1. Rest or reduce activity
When you have heel pain avoid any activity that can further aggravate the problem. This includes walking for long distances, walking up or down stairs, running, sports etc. If you want to keep fit swimming is the safest activity, until your heel pain has been treated properly. Or you can ride a bike or a stationary exercise bike. Basically, try to be as little on your feet as possible, allowing the plantar fascia to heal itself.
2. Cold & Hot therapy
Use an ice pack and apply it onto the sore heel for 5-10 mins at a time, 3 to 4 times per day. The ice will reduce the inflammation in the heel area. To help reduce any chronic inflammation, you can try alternating between ice and heat. Place an ice pack on the heel for 5 minutes and then switch to a hot pack (or hot water foot bath) for another 5 minutes. Do this for about 20-30 minutes per day and you’ll notice some considerable heel pain relief.
3. Roll a ball under the foot
Many people with Plantar Fasciitis experience a sharp heel pain in the morning, when taking the first steps after getting out of bed. This pain comes from the tightening of the plantar fascia that occurs during sleep. Stretching and massaging the plantar fascia before standing up will help reduce heel pain for the rest of your day! Massaging the plantar fascia can be done simply by rolling a tennisball (or rolling pin) under the foot, all the way from the heel to the toes. You may do this sitting down, applying a fair amount of pressure onto the arch, or even standing up as long this causes not too much discomfort. Keep rolling the ball or pin under the foot for about 5 minutes.
4. Stretch your feet with a towel
Stretching the plantar fascia is your next Plantar Fasciitis exercise, using a bath towel. Put a rolled up towel under the ball of one foot, holding both ends of the towel with your left and right hand. Next, slowly pull the towel towards you, while keeping your knee straight (the other knee may be bent). Hold this position for 15 to 20 seconds. Repeat 4 times and change to the other foot, if necessary. If you don’t have a towel handy, simply put your foot on your knee and grab your toes and pull them towards your shin, hold for about 10 seconds.
5. Stretch your calf muscles
Stand facing a wall with your hands on the wall at about eye level. Put one leg about a step behind your other leg, keeping your back heel flat on the floor. Make sure this leg stays straight at all times. Now bend the knee of the front leg slowly, lowering your body until you feel a stretch in the calf of the back leg. Hold the stretch for 15 to 20 seconds. Repeat 4 times. Do the same for the other leg.
Please make sure you don’t walk barefoot at home in the morning, as this will undo all the hard work! Wear shoes or supportive sandals as soon as you have done the Plantar Fasciitis exercises.
You can repeat any of these heel pain exercises during the day, if you wish. For example the tennis/golf ball rolling can be done as you watch TV or read the paper. There’s one more exercise you may want to do which is called the Achilles Tendon stretch. Stand on a step with both feet on the same step and slowly let your heels down over the edge of the step as you relax your calf muscles. Hold this stretch for about 15 to 20 seconds, then tighten your calf muscle a little to bring your heel back up to the level of the step. Repeat 4 times.
Please note that stretching exercises should create a pulling feeling, they should never cause pain!
6. Take an anti-inflammatory drug, like Ibuprofen
To ease your Plantar Fasciitis you can take an anti-inflammatory that contains Ibuprofen, like Nurofen or Advil. This is a short term fix that will help decrease the inflammation of the plantar fascia. You still need to do take all the other measures such as stretching, ice, orthotics etc to achieve long term pain relief from your heel problem. For many people Ibuprofen is pretty heavy on the stomach and therefore these drugs should be taken in moderation.
7. Lose some weight
As we get older we tend to put in a bit of extra weight. The combination of weight gain and ageing means we put a lot of extra tension on our muscles and ligaments in the feet, legs and back. Most people tend to over-pronate because of weight gain. Over-pronation (fallen arches) is the main cause of Plantar Fasciitis and heel pain. Therefore by losing weight you will decrease the tension on the plantar fascia.
8. Wear the right footwear
Supportive footwear is paramount, especially as we get older. Floppy footwear causes ankle instability during walking and contributes to the problem of over-pronation, leading to heel pain and other foot problems. A good supportive shoe should only bend at the sole in the forefoot area and should be firm elsewhere, especially the back section of the shoe (heel counter) should be firm. Many footwear companies advertise shock-absorption and cushioning as the major benefits of their (sports) shoes. Stability is far more important than cushioning!
9. Use a night splint
A night splint holds the foot at 90 degrees during your sleep. The aim of the splints is to keep your foot and calf muscles stretched during the night. Normally during rest the plantar fascia and calves tend to tighten and shorten. So when you wake up in the morning and take your first steps, the fascia are being pulled all of a sudden, causing the sharp pain in the heel.
The problem with night splints is that they can be quite uncomfortable. This is why they are so-called sock night splints on the market which are more bearable than rigid night splints.
10. Wear orthotics in your shoes
Research has shown that by far the most effective way to treat Plantar Fasciitis is wearing a corrective device inside the shoe. Orthotics are designed to correct the problem of over-pronation, the major cause of plantar fasciitis and heel pain. Orthotics support the arches and control abnormal motion of the feet, thereby greatly reducing the tension in the plantar fascia band. Especially when combined with daily exercises, orthotics will provide relief to the majority of Plantar Fasciitis sufferers. Orthotics can be obtained from a foot specialist (podiatrist). These are called custom orthotics and they usually quite hard. Nowadays there are softer orthotics on the market, which are made of EVA and which mould themselves to the wearer’s foot shape because of body heat and body weight. These softer orthotics are pre-made and available without a prescription from pharmacies and specialty websites.
The most common cause of heel pain and heel spurs is a condition called Plantar Fasciitis. This is Latin for inflammation of the Plantar Fascia. The Plantar Fascia is the broad band of fibrous tissue that runs under the foot and that forms your arch. Because of a number of different factors the plantar fascia are being overly stretched and this continuous pulling results in inflammation and pain at the heel bone, at the point where the ligaments insert into the heel bone.
Over-pronation of the feet (fallen arches + rolling inward of the feet and ankles), tight calf muscles, as well as ageing and being overweight are the main causes for the plantar fascia being overly stretched.
There are many ways to treat heel pain, heel spurs and Plantar Fasciitis, including cortisone injections and surgery. However, in most cases Plantar Fasciitis relief can be achieved through self-help by following a number of easy, simple steps, most of which are aimed at reducing the pulling of the plantar fascia:
1. Rest, reduced activity:
When you have Plantar Fasciitis avoid any activity that can further aggravate the problem. This includes walking for long distances, walking up or down stairs, running, sports etc. If you want to keep fit swimming is the safest activity, until your heel pain has been treated properly. Or you can ride a bike or a stationary exercise bike. Basically, try to be as little on your feet as possible, allowing the plantar fascia to heal itself.
2. Ice (can be combined with heat)
Use an ice pack and apply it onto the sore heel for 5-10 mins at a time, 3 to 4 times per day. The ice will reduce the Plantar Fasciitis inflammation in the heel area. To help reduce any chronic inflammation, you can try alternating between ice and heat. Place an ice pack on the heel for 5 minutes and then switch to a hot pack (or hot water foot bath) for another 5 minutes. Do this for about 20-30 minutes per day and you’ll notice some considerable heel pain relief.
3. Roll a tennis ball (or rolling pin) under the foot
Many people with Plantar Fasciitis experience a sharp heel pain in the morning, when taking the first steps after getting out of bed. This pain comes from the tightening of the plantar fascia that occurs during sleep. Stretching and massaging the plantar fascia before standing up will help reduce heel pain for the rest of your day! Massaging the plantar fascia can be done simply by rolling a tennisball (or rolling pin) under the foot, all the way from the heel to the toes. You may do this sitting down, applying a fair amount of pressure onto the arch, or even standing up as long this causes not too much discomfort. Keep rolling the ball or pin under the foot for about 5 minutes.
4. Towel stretch
Your next Plantar Fasciitis exercise is stretching of the plantar fascia using a bath towel. Put a rolled up towel under the ball of one foot, holding both ends of the towel with your left and right hand. Next, slowly pull the towel towards you, while keeping your knee straight (the other knee may be bent). Hold this position for 15 to 20 seconds. Repeat 4 times and change to the other foot, if necessary. (It’s always good to do these exercises on both feet, even if you only experience heel pain in one foot, as this will help prevent the heel problem to come back in your other foot!)
5. Stretch your calf muscles
Tight calf muscles is a major contributing factor to Plantar Fasciitis. Therefore this particular heel pain exercise is very important. Stand facing a wall with your hands on the wall at about eye level. Put one leg about a step behind your other leg, keeping your back heel flat on the floor. Make sure this leg stays straight at all times. Now bend the knee of the front leg slowly, lowering your body until you feel a stretch in the calf of the back leg. Hold the stretch for 15 to 20 seconds. Repeat 4 times. Do the same for the other leg.
Now you’re ready to face the day! Please make sure you don’t walk barefoot at home in the morning, as this will undo all the hard work and aggravate your plantar fasciitis. Wear shoes or supportive sandals as soon as you have done the heel pain exercises.
You can repeat any of these heel pain exercises during the day, if you wish. For example the tennis ball rolling can be done as you watch TV or read the paper.
There’s one more plantar fasciitis exercise you may want to do which is called the Achilles Tendon stretch. Stand on a step with both feet on the same step and slowly let your heels down over the edge of the step as you relax your calf muscles. Hold this stretch for about 15 to 20 seconds, then tighten your calf muscle a little to bring your heel back up to the level of the step. Repeat 4 times.
Please note that stretching exercises should create a pulling feeling, they should never cause pain!
6. Take an anti-inflammatory drug, like Ibuprofen
To ease Plantar Fasciitis and heel pain you can take an anti-inflammatory that contains Ibuprofen, like Nurofen or Advil. This is a short term fix that will help decrease the inflammation of the plantar fascia. You still need to do take all the other measures such as stretching, ice, orthotics etc to achieve long term pain relief from your heel problem. For many people Ibuprofen is pretty heavy on the stomach and therefore these drugs should be taken in moderation.
7. Lose some weight
As we get older we tend to put in a bit of extra weight. The combination of weight gain and ageing means we put a lot of extra tension on our muscles and ligaments in the feet, legs and back. Most people tend to over-pronate because of weight gain. Over-pronation (fallen arches) is the main cause of Plantar Fasciitis and heel pain. Therefore by losing weight you will decrease the tension on the plantar fascia.
8. Wear the right footwear
Supportive footwear is paramount, especially as we get older. Floppy footwear causes ankle instability during walking and contributes to the problem of over-pronation, leading to heel pain and other foot problems. A good supportive shoe should only bend at the sole in the forefoot area and should be firm elsewhere, especially the back section of the shoe (heel counter) should be firm. Many footwear companies advertise shock-absorption and cushioning as the major benefits of their (sports) shoes. Stability is far more important than cushioning!
9. Use a Plantar Fasciitis night splint
A night splint holds the foot at 90 degrees during your sleep. The aim of the splints is to keep your foot and calf muscles stretched during the night. Normally during rest the plantar fascia and calves tend to tighten and shorten. So when you wake up in the morning and take your first steps, the fascia are being pulled all of a sudden, causing the sharp pain in the heel.
The problem with night splints is that they can be quite uncomfortable. This is why they are so-called sock night splints on the market which are more bearable than rigid night splints.
10. Wear orthotics in your shoes
Research has shown that by far the most effective way to treat heel pain, plantar fasciitis and heel spurs is wearing a corrective device inside the shoe. Orthotics are designed to correct the problem of over-pronation, the major cause of plantar fasciitis and heel pain. Orthotics support the arches and control abnormal motion of the feet, thereby greatly reducing the tension in the plantar fascia band. Especially when combined with daily exercises, orthotics will provide relief to the majority of heel pain sufferers.
Orthotics can be obtained from a foot specialist (podiatrist). These are called custom orthotics and they usually quite hard. Nowadays there are softer orthotics on the market, which are made of EVA and which mold themselves to the wearer’s foot shape because of body heat and body weight. These softer orthotics are pre-made and can be very effective in the treatment of Plantar Fasciitis. They are available without a prescription from pharmacies and specialty websites.
People often talk about chores or personalities or jobs that are a pain in the neck. Just stop by the office water fountain or the coffee station after a weekend and you can invariably hear conversations of so and so or such and such a task being a pain in the neck and so on. But only people that suffer from plantar fasciitis can vouch for what it is to have a pain in the heels!
Plantar fasciitis is a condition wherein the sufferer feels significant pain in the heels very first thing in the morning and after long periods of inactivity such as after long lunches. The pain can sometimes be so severe in the heels that walking or moving around can be a real challenge. The pain usually goes away after some period of normal activity, but returns back the next day and the day after and so on like clockwork.
Plantar fasciitis is caused by an inflamation of the plantar fascia tissue that goes from the front of the foot to the heels. When the calf muscles lose their flexibility, this condition results that manifests itself by extreme pain in the heels. The onset of the condition is never sudden, but rather gradual.
Thankfully, several non-invasive treatment options are available for those that suffer from plantar fasciitis, including exercises, orthotic inserts, night splints and so on, without having to resort to surgery which is usually the last alternative. Hopefully you will never have to find out what a pain in the heels can feel like by avoiding this condition altogether!