What is Plantar Fasciitis?

Plantar Fasciitis is the pulling and micro tearing of the large ligament type structure under the foot called the plantar fascia at its insertion point at the heel. See figs. 1, 2 and 3.

The causes of this inflammation and tearing vary from patient to patient. From the Heel Clinic’s experience in treating over 5,000 patients, age, weight, long periods of time on feet at work, excessive forefoot sports or activity and starting exercise after years of inactivity, appear to be the most common reasons. But it is most certainly a weight-bearing functional problem of the feet.

Under normal conditions the structure of the foot supports body weight, but when that structure is no longer supportive (for reasons quoted above); the plantar fascial ligament takes excessive load. After time, (perhaps years) the fascia tears at the attachment point of the heel. Hence the acute pain. Bony spurs can develop as nature’s way of trying to repair itself but is rarely associated with the pain.

What is often not understood is that normal daily routine (standing, walking etc.) overloads the fascia. Standing for long periods, sport, exercise – just aggravate the injury and prevent the natural healing processes.

Symptoms:

Common symptoms for patients are: – pain first thing in the morning, aching and throbbing in the evening, pain when standing up after sitting or lying down and severe pain after sport or exercise.

The Three Phases of Plantar Fasciitis:

Plantar Fasciitis can progress through three (3) phases.

1. Dull pain usually in one foot ‘feels like a stone bruise’ – develops over 3-4 weeks.
(See Early Onset Treatment)

With continued daily routine, activity, sport, work etc., pain intensifies. Pain first thing in the morning, immediately on weight bearing.
Simple calf muscle stretching, ice, good supportive footwear and rest can often relieve Plantar Fasciitis in these early stages.

After this early period the pain can continue to intensify. Patients try anti inflammatories, heel cushions, physiotherapy, acupuncture, arch supports, massage, heat, orthotics, rolling the foot over cans/bottles/golf balls etc., and cortisone. By now most patients have ceased or greatly reduced their activity.

2. Intense pain now for probably 6-12 months, mostly all day, usually consistent in one foot.
Most patients have tried a vast array of treatments including multiple cortisone injections and have stopped all exercise, sport and sometimes jobs. This has obvious physical repercussions resulting in depression and negativity. In desperation, patients will try any solution and well meaning advice. Surgery is still being suggested in some quarters as a final solution.

3. Plantar fasciitis pain develops in “good foot” due to compensated body load (limping).
Secondary pain in knees, hips and lower back due to incorrect foot alignment and posture are common. Substantial increase in weight from lack of exercise adding to the load.

Pain can be acute and time frames of up to 5 years are not unusual. Pain can dissipate completely as the body adapts, but usually at great personal cost and lifestyle changes. This seems to be between 2 and 5 years. Research shows in nearly all cases it will return as the patient increases time on feet again and returns to activities. This is due to patient’s foot type and the inherent weakness. Plantar Fasciitis can potentially be a lifetime ailment.

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