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.
Foot cramps are caused by muscles suddenly spasming uncontrollably. They most commonly cause foot arch pain but can occur anywhere in the foot and lower leg. Usually, they only last a few seconds but in more extreme cases they can continue longer. Often, there is no obvious reason why people suffer from foot cramps, but possible causes include diet, muscle tightness and weakness, dehydration, reduced circulation and fatigue. Sometimes, it can be a sign of an underlying medical condition so if the problem keeps recurring, do consult your doctor. Some of the best ways to reduce the incidence of foot arch pain from cramps include doing exercises, using heat, drinking plenty of water, using toe stretchers and ensuring you are wearing good footwear.
Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains.
The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise.
Non Surgical Treatment
In mild cases of flatfoot the first line of treatment is often custom orthotics. In patients with a flexible deformity, supporting the arch with a custom arch support will take the strain off the joints and muscles, bringing the heel into a corrected position. Wider shoe gear may be prescribed to accommodate foot pain and motion and stretching exercises to decrease stiffness and stress on the foot. In cases of severe collapse, especially if the patient is not a good surgical candidate or has a mild tear, a brace may be made to accommodate the foot and ankle, thus supporting the arch and ankle.
Although most patients with plantar fasciitis respond to non- surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstays of long-term treatment for plantar fasciitis.
Foot and ankle injuries are common in sports, especially running, tennis and soccer. But sports enthusiasts can decrease the risk of injury by taking some precautions. Lightly stretch or better yet, do a slow jog for two to three minutes to warm up the muscles. Don't force the stretch with a "bouncing motion." The amount of time spent on the activity should be increased gradually over a period of weeks to build both muscle strength and mobility. Cross training by participating in different activities can help build the muscles. People whose feet pronate or who have low arches should choose shoes that provide support in both the front of the shoe and under the arch. The heel and heel counter (back of the shoe) should be very stable. Those with a stiffer foot or high arches should choose shoes with more cushion and a softer platform. Use sport-specific shoes. Cross training shoes are an overall good choice; however, it is best to use shoes designed for the sport.
You may start exercising the muscles of your foot right away by gently stretching and strengthening them. Frozen can roll. Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This exercise is particularly helpful if it is done first thing in the morning. Towel stretch. Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your leg straight. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. Standing calf stretch. Stand facing a wall with your hands on the wall at about eye level. Keep your injured leg back with your heel on the floor. Keep the other leg forward with the knee bent. Turn your back foot slightly inward (as if you were pigeon-toed). Slowly lean into the wall until you feel a stretch in the back of your calf. Hold the stretch for 15 to 30 seconds. Return to the starting position. Repeat 3 times. Do this exercise several times each day. Seated plantar fascia stretch. Sit in a chair and cross the injured foot over the knee of your other leg. Place your fingers over the base of your toes and pull them back toward your shin until you feel a comfortable stretch in the arch of your foot. Hold 15 seconds and repeat 3 times. Plantar fascia massage. Sit in a chair and cross the injured foot over the knee of your other leg. Place your fingers over the base of the toes of your injured foot and pull your toes toward your shin until you feel a stretch in the arch of your foot. With your other hand, massage the bottom of your foot, moving from the heel toward your toes. Do this for 3 to 5 minutes. Start gently. Press harder on the bottom of your foot as you become able to tolerate more pressure.