Plantar Fasciitis

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[edit] Plantar Fasciitis

This is one of the causes of heel pain. Deep inside the sole of the foot there is a flat sheet of connective tissue (called the "plantar fascia"), which helps to approximate the forefoot to the heel. With prolonged standing the plantar fascia can get inflamed and degenerative changes can take place close to the insertion of the plantar fascia near the heel bone.

This leads to heel and foot pain and discomfort. This is usually associated with a heel cord contracture. At night the foot is usually plantar flexed (toe pointed downwards) and this aggravates the heel cord contracture. When the toes are bent upwards (dorsiflexed), the pain of plantar's fasciitis is worsened. This is one of the diagnostic signs.

There is no connection between flat foot and plantar's fasciitis, they are independent conditions. Plantar fasciitis treatment
consists of stretching exercises of the heel cord to improve postural factors. Any repetitive loading stress of the foot needs to be avoided such as running or prolonged standing. Plantar fasciitis shoes and plantar fasciitis night splints might help.
Surgery for plantar fasciitis is indicated in less than 5% of cases and would consist of a plantar fascia release. Fitted orthotic devices may be needed to redistribute some of the forces from the plantar fascia (Ref.3) thus helping with the heel pain and foot heel pain associated with plantar fasciitis.

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References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 5.

2. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.

3. Wheeless' Textbook of Orthopaedics: http://www.wheelessonline.com/

4. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 60, p.487.

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