Symptoms of Plantar Fasciitis

The main symptom of Plantar Fasciitis is pain in the center of the heel with weight bearing.  This is usually worse in the morning when the foot is first placed on the floor. The pain associated with Plantar Fasciitis is gradual in onset and is usually located over the inner aspect of the heel.  Pain may also occur in the arch area of the foot.  Occasionally, the pain will be sudden in onset, occurring after missing a step or after jumping from a height.  This condition causes what is known as “first-step pain.”  The degree of discomfort can sometimes lessen with activity during the course of the day or after “warming-up”, but can become worse with prolonged or vigorous activity.  The pain may also be more severe in bare feet, in shoes with little or no padding at the sole, and slippers.

Causes of Plantar Fasciitis

Plantar Fasciitis has been linked to excessive stress placed on the tissue as a result of athletic activity, muscle weakness or tightness, improper shoes, increase in body weight, aging, inadequate footwear and occupation.  

Age

As we age, the fat pad that makes up the fleshy portion of the heal becomes thinner.  This leads to inadequate padding on the heel and chronic pain in this area.

Trauma

The primary cause is some degree of microtrauma and tearing at the site of plantar fascia insertion.  

Obesity

Being overweight places a lot of stress on this area and may be a causative factor. Obesity is a cause and initiator of heel pain and Plantar Fasciitis/calcaneal spur and that improper footwear aggravates the condition. Individuals who spend the majority of their workday on their feet and those whose body-mass index is >30 kg/m2 are also at increased risk for the development of Plantar Fasciitis .

Flat Foot 

Flat foot is the leading cause of Plantar Fasciitis. Over-pronation occurs in the walking process, when a person's arch collapses, causing the plantar fascia to be stretched away from the heel bone. Pronated foot types are predisposed to increased stress on the plantar fascia with reduced ankle dorsiflexion appearing to be the most important risk factor.”  Based on this information gait testing should be performed on all clients diagnosed with Plantar Fasciitis/heel spurs.

High Arches 

The most common cause of Plantar Fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches—either overly flat feet or high-arched feet—are more likely to develop Plantar Fasciitis.

Flooring and Footwear

The harder the floor, the higher the force subjected to the feet.  Newton’s third law states that “for every action there is an equal and opposite reaction”.  When walking on a hard floor, the foot strikes the floor, but the floor also strikes back equally resulting in injury to the base of the foot. Poor cushioning can often be found in footwear with a high heel, hard sole, poor support, inadequate size, and inadequate width. Stiff shoes require more flexibility in the calf muscles by increasing the length of the foot which requires the foot to bend back further when walking.  If the foot cannot bend back that far it results in increased tension on the plantar fascia.  

Gender

If women gain weight in their thighs and hips and men gain weight in their chest and belly, then a woman's lowered center of gravity could help explain why women are 6 times more likely than men to have heel pain. The combination of women's shoes and being overweight could have a combined negative effect on the plantar fascia.

Prolonged Weight Bearing

Occupations requiring prolonged weight bearing have been considered a risk for Plantar Fasciitis due to the repetitive tensile load placed on the fascia (Riddle et al. 2003).

Fat Pad Atrophy

Atrophy or shrinking of the fat pad results in the loss of the natural shock absorption of the heel resulting in increased stress being applied to the plantar fascia.

Other Conditions

Conditions such as reduced dorsiflexion, Equinus, shortened Achilles tendon, leg length discrepancies, tarsal coalition, weak plantar flexor muscles, rear foot varus, forefoot valgus weak intrinsic muscles of the foot, and excessive subtalar joint pronation can also contribute to the development of Plantar Fasciitis.  In addition, systemic inflammatory disorders, such as rheumatoid arthritis, lupus, Reiter’s syndrome and psoriasis, may produce Plantar Fasciitis.  

Diagnosis

Plantar Fasciitis is diagnosed during a history and physical examination by a doctor.  There are several conditions that may cause heel pain, and Plantar Fasciitis must be considered. An X-ray may be taken to determine if a stress fracture of the heel bone is present and to see if a bone spur is causing problems. Laboratory investigation may be necessary in some cases to rule out other illnesses that can cause the heel pain, such as rheumatoid arthritis, Reiter's syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but can show up at first as pain in the heel.

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