PLANTAR FASCIITIS
Plantar fasciitis (PF) is a common cause of heel pain in adults. The PF is a
fibrous band that holds the arch in your foot, much like the guide wires of a
suspension bridge. When it overstretches, the patient will experience pain in
the arch or heel, or both. The disorder usually presents itself with arch/heel
pain that is severe during the first few steps taken in the morning.
Plantar fasciitis is due to repetitive or excessive loads on the plantar
fascia It causes a sometimes debilitating pain on the bottom of the foot and
heel in both active and sedentary populations. Although the term "fasciitis"
implies an inflammatory process, recent research indicates a non-inflammatory,
degenerative process with thickening of the plantar fascia may be the cause.
PREVENTION: 1. Obesity is a consistent risk factor in the literature. A
body mass index of >30 increases risk up to five times compared to those with a
BMI of <25.
2. Excessive standing on feet: Activities that require an individual to spend
a majority of their time weight bearing increase the risk of PF. Runners also
have an increased incidence of PF
3. Limited ankle flexiblity. A systematic review of 16 separate studies
stated limited abiltiy to point your toe to your nose is a risk factor.
4. Poor arch support in shoes Although long accepted as a risk factor, only
one study was located that directly related poor arch support to an increased
risk of PF.
5. Tight hamstring muscle : A single study of 15 participants showed tight
hamstrings contributed to increased forefoot loading and may contribute to PF.
TREATMENT 1. Stretching: The first treatment option would be stretching of
the plantar fascia by actively extending the toes , stretching the Achilles
tendon, and stretching the hamstring.
2. Shoe Inserts: Both custom made and prefabricated inserts have been
evaluated and found effective in a limited number of low quality studies.
3. Splints: The effectiveness of night splints is equivocal.
4. Chiropractic manipulation of the foot : A single small study of 20
subjects compared manipulation of the foot and ankle and stretching with a
control group using orthotics. Both groups showed improvement over baseline with
the manipulation group being superior over orthotics for "worst pain"
measurements A retrospective case series of 29 subjects treated with
manipulation, orthotics and physiotherapy found the intervention to be
effective. Twenty-two of the subjects had greater than a 75% reduction in pain.
5. Taping : Anecdotal evidence suggests taping or strapping may be an
effective method to treat PF although there is no evidence available to support
this contention .
6. Cold Laser
