This week we are going to discuss plantar fasciitis, a very common condition of the feet which is sometimes misunderstood, often misdiagnosed and can be extremely debilitating for the patient.
The plantar fascia is a long ligament which is designed as shock absorber or type of structural support for the medial longitudinal arch of the foot and as such, is susceptible to wear and tear as it absorbs shock and provides cushion for the foot. When a patient with a flat foot has plantar fasciitis it is usually due the fact that they are over pronating the foot and over stretching the plantar fascia to the point that they are tearing it away from the calcaneus (heel bone).
Structural support in the form or orthotics in shoes can often reduce the stress on the plantar fascia and decrease the amount of tearing of the fascia at it’s attachment to the heel. Plantar fasciitis in the flat footed patient is often successfully treated with orthotics, dry needling, as well as taping and stretching as an adjunct to traditional therapy such as rolling a frozen water bottle on the bottom of the foot and decreasing activity, as well as wearing good structurally supportive shoes.
Plantar fasciitis in the high arched patient is a similar animal for a different reason. The plantar fascia is generally extraordinarily tight in a patient with a thigh arch, and therefore, it is strung tight like a bow string most of the time. When the patient steps down, the plantar fascia takes much of the stress and with repetitive movement such as walking or running the patient suffers a similar fate, i.e. tearing at the attachment to the heel and subsequent heel pain.
Treatment of plantar fasciitis without proper calf flexibility is often unsuccessful as the addition of an orthotic to the shoe takes the structural control off of the foot and transfers to the lower leg via the triceps surae or Achilles tendon complex. In doing so it places the patient at risk of developing another painful condition called Achilles tendonosis. However, proper stretching technique of both the gastrocnemius and soleus muscle as prescribed by a physical therapist will help alleviate this concern. There are also new cutting edge techniques such as shock wave therapy (ESWT) which is extremely effective in the treatment of plantar fasciitis.
As you can see plantar fasciitis is not as simple as it seems and we have not even discussed things such as a spur in the heel, and other conditions which mimic plantar fasciitis such as tarsal tunnel syndrome (will get to that later). For these reasons it is important to properly diagnose the condition in order that the treatment match the symptoms. For more information on plantar fasciitis, prescription orthotics and the application of innovative treatments, please contact the clinic for a no cost consultation.
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July 13, 2020 at 11:15PM
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Plantar fasciitis—A condition of extremes - South Platte Sentinel
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