Overview

The plantar fascia is a sturdy structure but the degree of stress that it takes makes it susceptible to injury. A force equal to almost three times body weight passes through the foot with each step. On running, this typically happens about 90 times a minute. Plantar fasciitis is thought to be a traction and overuse injury. Damage to the plantar fascia is usually in the form of micro-tears. It is a degenerative rather than an inflammatory process. Damage tends to occur near the heel, where stress on the fibres is greatest, and where the fascia is the thinnest. The fascia broadens as it extends toward the toes.

Plantar fasciitis is often associated with calcaneal spurs. These are depositions of calcium where the fascia suffers most damage. Spurs are most commonly on the medial side at the origin of the fascia from the calcaneum. Spurs are the result of the process of plantar fasciitis and not the cause of the pain. It can present bilaterally.

Arch Pain


Causes

There are a variety of causes of flat feet. Flat feet can be genetic, acquired and develop over time. Young children and teens can have no arches. Injury can lead to flat feet. Tendon problems, and arthritis can lead to flat feet. Rigid flat feet may occur from a condition called tarsal coalition, where the bones in the back of the foot are genetically fused or locked together.


Symptoms

Pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot and may manifest either as a specific or general area of tenderness. Plantar fascia pain may be increased or decreased by stretching of the arch. Generally, in mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot “warm up”; however, pain may increase as use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed. A more specific pain (point tenderness) is an indicator that something is wrong in that specific area. Pain with movement of the affected area is also an indicator of the particular body part affected.


Diagnosis

The diagnosis of high arch (cavus) foot deformity or Charcot Marie Tooth disease can be made by an orthopedic surgeon in the office. Evaluation includes a thorough history and physical examination as well as imaging studies such as X-rays. The orthopedic surgeon will look at the overall shape, flexibility, and strength of a patient?s foot and ankle to help determine the best treatment. Nerve tests may occasionally need to be performed to help confirm the diagnosis.


Non Surgical Treatment

The treatment is to put an arch support under the foot immediately to prevent the arch from collapsing and the plantar fascia from stretching. Also, put an arch support in your slippers and wear them as soon as you rise. Even a few steps barefoot without support can stretch the plantar fascia. Arch supports usually relieve pain within a few days. To head off arch pain, begin an exercise routine slowly, take off any excess weight and wear arch supports in your athletic shoes. Arch pain commonly smolders for months because people do not take the proper precautions. Continuing to do weight-bearing exercises will perpetuate the pain. While the foot is recovering, swim or do water workouts. Or work the upper body only. Some people are able to use a stationary bicycle by placing only the front part of the foot on the pedals.

Foot Arch Pain


Surgical Treatment

The soft tissue surgeries usually would include a lengthening of the Achilles tendon, releasing of the plantar fascia as well as tendon transfers. These procedures are usually done in conjunction with bony procedures such as calcaneal osteotomies (to lower the heel bone and get it more under the leg itself), as well as metatarsal osteotomies. These procedures usually involve either cutting or fusion of the bones, and placement of fixation devices to allow the bones to heal. Healing time is usually at least 6-8 weeks and usually the patient must be non-weight bearing during the healing process. These types of surgical corrections are usually reserved for the more difficult, painful and deformed feet. They can require more surgeries down the line. These procedures are usually the last resort after all other modes of treatment have been exhausted (except in children where it is usually best to treat the deformity early). There are many different degrees of high arched feet and these procedures should be left for the more extreme cases. These cases usually require a very high degree of surgical skill and should only be done by those who frequently perform these types of cases.


Prevention

Warm up properly. This means not only stretching prior to a given athletic event, but a gradual rather than sudden increase in volume and intensity over the course of the training season. A frequent cause of plantar fasciitis is a sudden increase of activity without suitable preparation. Avoid activities that cause pain. Running on steep terrain, excessively hard or soft ground, etc can cause unnatural biomechanical strain to the foot, resulting in pain. This is generally a sign of stress leading to injury and should be curtailed or discontinued. Shoes, arch support. Athletic demands placed on the feet, particularly during running events, are extreme. Injury results when supportive structures in the foot have been taxed beyond their recovery capacity. Full support of the feet in well-fitting footwear reduces the likelihood of injury. Rest and rehabilitation. Probably the most important curative therapy for cases of plantar fasciitis is thorough rest. The injured athlete must be prepared to wait out the necessary healing phase, avoiding temptation to return prematurely to athletic activity.


Stretching Exercises

Inchworm. Stand with your weight on one foot. Raise the metatarsal heads of the unweighted foot while you pull its heel closer to your toes. Next, raise your toes toward the ceiling, and then relax your whole foot with it flat on the floor. Your foot should move like an inchworm across the floor. Reps 6-7 for each foot. Horsepawing. Stand with your weight on one foot and the other foot slightly in front of you. Raise the metatarsal heads on the front foot. Lift your heel ever so slightly off the ground, maintaining the raised metatarsal heads, and pull your foot toward you so that it ends up behind you. Return this foot to the starting position in front of you. You should really feel this one in your arch. Reps. 6-7 for each foot. Toe pushups. Sit in a chair with your feet resting on the floor. Raise your heel as high as you can while keeping your toes flat on the floor. This is the starting position. Using your toe muscles, roll your foot upward until the weight of your foot is resting on the ends of your toes, like a dancer standing on point in toe shoes. Roll back down to the starting position. Reps. 10-20 for each foot. Sand scraping. Pretend you are at the beach standing in loose sand. Use your big toe to pull sand inward toward your body, with your little toe off the ground. Then use your little toe to push it away, with your big toe off the ground. Reps. 10 for each foot. Now reverse the exercise: pull the sand inward with your little toe and push it away with your big toe. Reps. 10 for each foot.