Foot & ankle pain
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The plantar fascia is a dense, fibrous band serving as a biomechanical stabilizer as well as a protector to the vulnerable structures on the base of the foot. The diagnosis “plantar fasciitis” refers to disorders ranging from acute inflammation to chronic degeneration of the band of tissues across the bottom of the foot from the heel to the toes.
The band normally functions, via the “windlass mechanism” to stabilize the foot during gait. This is a function that allows the tissues on the sole of the foot to go slack during the “planting” phase of gait, letting the foot accommodate uneven surfaces. When the heel lifts off the ground, the foot fascia “winds up” pulling itself taut, raising the arch which makes it easier to push off the ground with the forefoot.
Plantar fasciitis is a result of repetitive chronic overload that results in a breakdown of the normal inflammatory process and results in a disorganized healing process that fails to regenerate normal tissue.
Plantar fasciitis is the most common cause of plantar heel pain, affecting approximately 10% of the population. The condition is responsible for one quarter of all foot injuries. The condition is common in young runners and middle-aged women, but the majority of plantar fascia patients are over the age of 40. (16-18)
The leading cause for plantar fasciitis is pes planus (fallen arch) which increases tension on the plantar fascia, leading to repetitive microtrauma. Halux valgus (where the big toe typically presents with a bunion is another known risk factor for plantar fasciitis.
Tightness or weakness in the calf muscle directly contributes to plantar fasciitis by increasing strain on the plantar fascia. The greater the calf tightness the greater the severity of plantar fasciitis symptoms.
Patients with plantar fasciitis are almost 9 times more likely to demonstrate hamstring tightness. Rapid weight gain and obesity are also recognized contributors to plantar fasciitis. Patients with BMI’s greater than 35 are approximately 2.5 times more likely to experience plantar fasciitis as compared to those with BMI’s less than 35.
Patients may be predisposed by occupations or activities that involve prolonged ambulation including: teachers, construction workers, cooks, nurses, distance runners, etc. The plantar fascia must absorb up to seven times body weight during the push off phase of running and biomechanical deficits are quickly amplified.
The most common complaint of plantar fasciitis is a sharp pain with the first couple of steps in the morning or following any period of prolonged inactivity. Symptoms are often noted when a person is pushing off the forefoot (the footpad and toes) when taking a step during walking or running. Symptoms are amplified by prolonged weight bearing, especially when wearing inadequate foot support or walking barefoot. Walking upstairs and sprinting or forefoot running tends to exacerbate symptoms by increasing plantar fascia strain. Patients report relief when unloading the foot by sitting or lying down. Symptomatic episodes are more frequent following periods of inactivity late in the day.