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Plantar Fasciitis

Plantar Fasciitis and heel pain can be very painful.

Plantar fasciitis (sometimes called “plantars” or “plantar fascitis”) involves pain across the bottom of the foot, usually near or on the heel of the foot itself. Although we don’t often think about our feet, they’re a very complex part of the body. To understand plantar fasciitis, it can help to understand how the foot works.

Foot anatomy

The foot is made up of twenty-six bones and 33 joints in each foot. On top of that, there are nineteen muscles and one hundred and seven ligaments.

The foot s generally divided into three parts; the forefoot, the mid foot and the hind foot (the hind foot being where the heel – medically known as the calcaneus – is).

The foot has many layers of muscle, fascia and bone as shown on this anatomical diagram from RAPID NeuroFascial Reset

Foot ligaments

Ligaments are strong connective tissues that connect bones to bones. The three main ligaments in the foot that can be linked to foot pain, heel pain or even ankle pain are the plantar fascia, the plantar calcaneonavicular ligament and the calcaneoocubiod ligament.

The plantar fascia is the main ligament involved in plantar fasciitis. It’s the longest ligament in the foot, and runs from the heel, along the sole of the foot to the toes, in a “bowstring” shape. Structurally, it forms the arch of the foot, and assists with balance and walking.

The plantar calcanonavicular ligament joins the calcaneus (that’s the heel bone) to a bone called the navicular, which is a bone in the mid foot. It also helps support the head of the talus – the bone that makes up the ankle joint.

The calcaneocubiod ligament joins the calcaneus to a bone called the cuboid, which (like the navicular) is a bone in the mid foot.

Plantar Fasciitis

Since the average person has covered around seventy-five thousand miles by the time they’re fifty years old, the odd injury shouldn’t be a major surprise, and plantar fasciitis is relatively common, although it can vary in severity and duration.

In plantar fasciitis, inflammation and / or tiny tears to the plantar fascia cause pain in the area of the heel or slightly along the sole of the foot. The pain is generally worse first thing in the morning, after getting out of bed, and many people will describe it as a “stabbing” feeling in the heel.

Moving around will often cause the pain to decrease or even vanish, but sitting for a long time and then standing, or standing for a long time, can cause the pain to return.

Plantar fasciitis can be linked to inflammation at the heel as shown in this anatomical drawing by RAPID NeuroFascial Reset

Plantar fasciitis causes and risk factors

The bowstring shape of the plantar fascia allows it to support the arch of the foot and act like a shock absorber. Whilst it performs this function very well, if the fascia undergoes too much stress or tension, small tears and inflammation can occur, which cause the pain so familiar to plantar fasciitis sufferers.

Unlike a muscle tear or a broken bone, there’s rarely one specific injury that someone with plantar fasciitis can point to as the cause of their injury. There are, however, factors that can put people more at risk of having the condition. Age is one such factor – it is a condition most commonly seen in people between forty and sixty years old, and it is believed that being overweight can also be a factor.

Certain types of gait (the way you walk) and foot structure is also a possible risk factor. Flat feet (where the foot has a very low arch) or very high arches can stress the plantar fascia, because the weight of the body is distributed in an uneven pattern, which is also why certain types of gait can be an added risk factor.

Plantar fasciitis is also more common with certain types of sports or exercise that others – sports which put more stress on the heel such as ballet, some aerobics and long distance running can contribute to stress across the fascia.

Long periods of standing on hard surfaces has also been suggested as a risk factor for the condition.

Diagnosis and treatment

It’s not normally necessary to use any kind of imaging treatment to recognise plantar fasciitis, although it is possible that – depending on your description of the pain and what can be felt – that an x-ray or MRI may be suggested to rule out any fractures. X-Rays can show bone spurs or heel spurs which, in the past, were blamed for pain in the heel – however, while the spurs can be seen, they are often not to blame, and many people have spurs and do not have any pain.

Treatment for plantar fasciitis focuses on relieving the symptoms as the foot heals. Stretching and manipulation by a soft tissue therapist can help, and should the therapist be trained in kinesiology taping, taping can sometimes be used to support the bottom of the foot. Often, the discomfort of plantar fasciitis can cause a change to the way the sufferer will walk, and this can cause stiffness or pain in the lower leg muscles, which soft tissue therapy can also assist with.

Sometimes, steroid injections may be offered. Whilst these can provide temporary relief, repeated injections have been linked to possible weakening of the fascia, which is definitely not wanted!

Preventing plantar fasciitis

Prevention is better than cure, and there are things you can do to lessen your risk of plantar fasciitis in the first instance, and reduce the likelihood of a reoccurrence if you’ve already had it.

Being a healthy weight can mean that less pressure or weight is put through the foot and the fascia, and supportive shoes can help whilst things heal. There is conflicting advice about walking barefoot, but wearing worn out shoes, perhaps with sloping soles or uneven support from wear, won’t help.

Making sure to stretch out the calf muscles and feet can help prevent plantar fasciitis. Icing can also help reduce the pain – a common technique is to fill a small water bottle with water and then freeze it. To apply to the foot, place the bottle on it’s side on the floor, and then the sole of the affected foot on top of the bottle, and (using the foot) roll the bottle across the floor so that the cold bottle is moving up and down the sole of the foot.

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