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What is plantar fasciitis?



Introduction: What is plantar fasciitis?

Plantar fasciitis, also called plantar fasciitis, calcaneal enthesopathy or calcaneal spine syndrome, is a painful condition resulting from the degeneration of the plantar fascia, also known as plantar fascia.  However, the more generic term plantar fasciapathy should replace that of plantar fasciitis, since it allows to group inflammatory and non-inflammatory conditions. 


Plantar fascia is a thick band of tissue in the soles of the feet that extends from the heel bone to the base of the toes. Plantar fascia plays an important role in walking and running by providing support to the arch and absorbing impacts at the foot. This thick band of tissue is able to absorb up to 110% of our weight during walking and up to 250% of our weight during running, hence its important role in the normal biomechanics of the foot. 


Plantar fasciapathy is one of the most common causes of heel pain in patients. About 10% of the population will have fasciapathy in their lifetime. It mostly appears in adults aged 25 to 65. This condition is even more prevalent, up to 22%, in the running population and represents 8% of all injuries in this population. 


Causes and risk factors 

Plantar fasciapathy is mostly presented as an overuse injury caused by micro-tears in the plantar fascia as a result of repeated stress on it. It can also be caused by trauma to the fascia during a sprained ankle or a broken foot for example and several other multifactorial causes. Risk factors for plantar fasciapathy include: 

  • Sedentary lifestyle

  • Obesity

  • Sudden increase in activity level

  • Activities involving standing or walking on hard surfaces for extended periods of time 

  • Running and dancing 

  • Wearing high heels or changing the height of heels

  • Wearing shoes that are inadequate or offer less stability 

  • Anatomical variability at the feet (flat feet and hollow feet)

  • Poor foot biomechanics

  • Decreased dorsal flexion of the foot 

  • Leg length difference (length asymmetry)

  • Muscle tension in the calf muscles (stiffness of the Achilles tendon causing an overload on the fascia)

  • Calcaneal spur (Thorn of Lenoir)

  • Rheumatoid arthritis or other types of arthritis

  • Injections of corticosteroids in the foot

  • Symptoms and diagnosis 


Plantar fasciapathy presents mainly with pain that can appear gradually on the plantar face of the foot, but mainly at its insertion point on the heel bone, either on the plantar and inner side of the heel and which can sometimes radiate to the toes. People with plantar fasciapathy will experience pain during activities with foot loading, mainly during the first steps following a period without prolonged loading, such as the first steps of the day, since the tissues are less stretched. The pain will also increase when the heel is lifted from the ground (climb on the front of the foot) and when walking without shoes. It will gradually decrease with walking and physical activities, because the body tissues will be more flexible. However, in times of irritation or inflammation, the pain may increase gradually during the day. 


The diagnosis of plantar fasciitis is primarily a clinical diagnosis based on the history of pain and physical examination of the foot that can be done by a health professional who has expertise in musculoskeletal injuries such as a physiotherapist. On physical examination, the physiotherapist will reproduce the pain on palpation at the insertion of the plantar fascia and during the dorsal flexion of the foot (foot 90 degrees) and the extension of the toes. Despite the rather simple diagnosis to determine, it is important to see a physiotherapist so that he can make a complete assessment of the foot and eliminate other diagnoses such as tarsal tunnel syndrome, a lumbar problem causing irradiated pain in the foot, a stress fracture of the calcaneus, a partial or complete tear of the fascia or even rheumatoid arthritis. An accurate assessment that explains the causes of plantar fasciapathy helps to better direct treatment. 


Imaging tests such as X-ray or MRI are usually unnecessary for the diagnosis of plantar fasciitis. However, the physiotherapist may request an imaging test if the history or physical examination indicates another injury or condition or if there is no improvement in pain following physiotherapy treatment after a reasonable period of approximately 3 months. If necessary, they can guide you to the best imaging test. 


During imaging tests, a calcaneal spine, more commonly called a Lenoir spine, can be highlighted. However, studies show that the existence of a calcaneal spine does not necessarily confirm a plantar fasciapathy and that it is generally not the cause of its symptoms. 



Treatments 

Following the physiotherapy assessment, the physiotherapist may create a specialized treatment plan for fasciapathy. Following it, there should be a rapid improvement in acute pain and a general improvement in pain in the first weeks after the start of treatments. However, despite a gradual improvement in the condition of the fascia, it is important to know that it can usually take several weeks or even months before the fascia regains its ability to withstand the same mechanical stress as the other foot. 


According to studies, about 80% of patients with plantar fasciapathy will have a complete or almost complete disappearance of foot pain in the first 12 months with conservative treatments (exercises, physiotherapy, taping...). Plantar fasciapathy can be considered a benign condition, but it can lead to multiple disabilities and moderate to severe pain if not treated properly. Also, multidisciplinary work with a doctor, acupuncturist, podiatrist or pharmacist, for example, could be suggested by the physiotherapist to find complementary treatments to the exercise program in physiotherapy.


In terms of conservative treatments, the physiotherapist will start by informing you more about the condition and how to properly modulate your activities. Indeed, it is very important to reduce mechanical stress in the fascia by discharging the foot to allow optimal healing and a decrease in pain in the foot. He can guide you precisely in this process to help you in the management of mechanical stress on the fascia. Also, by his extensive assessment of the injury, he is able to identify the intrinsic or extrinsic factors that are responsible for the injury. Afterwards, he will establish a program of targeted exercises according to the list of problems such as strengthening or stretching exercises for your foot and ankle. Sometimes night splints may be prescribed to allow for constant stretching of the fascia during sleep.  The physiotherapist will guide you to other treatments that may be useful depending on your condition.


If the pain does not respond to conservative treatments, more advanced or invasive techniques can be used in complementarity. These include injections, taking oral corticosteroids or even immobilizing in a plaster or walking boot if other alternatives have failed.  The work between the physiotherapist and your doctor will be essential at this stage. In addition, acupuncture treatments can also be prescribed for the treatment of tension points in the foot. Radial shock wave therapy is a technique that could also be used and consists of sending shock waves at the fascia to encourage blood circulation and promote healing. A referral with a podiatrist could also be recommended based on your needs and condition in order to complete the treatment.


Finally, if the physiotherapy treatment plan in addition to other treatment methods has not managed to reduce pain within a reasonable time, the physiotherapist may refer you to the doctor to consider the possibility of surgery. However, it is important to note that surgery is a treatment of last resort when all other less invasive treatments have not been conclusive, as it can have several complications and it does not necessarily guarantee a good result.


Advice and treatment while waiting to be seen by a health professional

If you suspect that you have plantar fasciapathy on one or both of your feet, although it is more rare, it is important to make an appointmentyou with a physiotherapist so that he can make a full assessment of the condition and confirm the diagnosis. 


While waiting for your appointment, there are a few treatments to do at home to reduce your pain. First, it is important to discharge the affected foot to limit mechanical stress in the fascia. To unload the foot, avoid activities that cause pain, such as running or jogging. Make sure to walk at all times with comfortable shoes such as sports shoes and use a technical aid such as a cane if the pain when walking is too much. In addition, you can do deep massages on the sole of your foot with a tennis ball to alleviate pain.


In conclusion, plantar fasciapathy is pain from the plantar fascia, also called plantar fascia, which consists of tissue damage as a result of repeated stress on it. It normally presents as pain in the plantar and internal side of the heel, mainly in the morning.  It is important to consult a physiotherapist quickly to help you treat this problem.


 For any questions, our certified physiotherapists and sports therapists, available in our two points of service, will be able to answer your questions and help you. 


Make an appointment online or contact us at 450-641-4610 to get an appointment quickly.



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