Plantar Fascitis / Heel Spurs |
 Plantar fascitis is a common foot problem
in sports participants. It starts as a dull intermittent
pain in the heel which may progress to a sharp persistent
pain. Classically, it is worse in the morning with
the first few steps or at the beginning of sporting activity.
The plantar fascia is a thick fibrous material
on the bottom of the foot. It is attached to the heel
bone (calcaneus) and fans forward toward the toes. It
is responsible for maintaining the arch of the foot.
The problem usually occurs when part of
this inflexible fascia is pulled away from the heel bone. This
causes an inflammation and thus pain. Plantar fascia
injuries may occur at the midsole or towards the toes. Since
it is difficult to rest the foot, a vicious cycle is set up
with the situation aggravated with every step. In severe
cases, the heel is visibly swollen. The problem progresses
rapidly and treatment must be started as soon as possible.
As the fascia is pulled away from the bone,
the body reacts by filling in the space with new bone. This
causes the classic "heel spur." This heel spur
itself is a secondary X-ray finding and is not the problem,
but a result of the problem.
Predisposing Factors
-
Flat pronated feet
-
High arched rigid feet
-
Inappropriate or improper shoes
-
Toe running, hill running
-
Soft terrain (i.e. running in the
sand)
-
Increasing age
Treatment
-
Arch Supports - These are
custom made from molds taken of your feet.
-
Rest - Use pain as your guide. If
your foot is too painful, bearing sports can be temporarily
replaced by swimming and/or cycling to maintain cardiovascular
fitness. Weight training can be used to maintain
leg strength.
-
Ice - Icing your heel (frozen
peas) for 15 minutes several times a day will reduce
inflammation. You should also ice your heel after
activity for 15 minutes.
Medication
A physician may on rare occasions prescribe
anti-inflammatory pills. These are important in reducing
the inflammation in your foot.
Physiotherapy
The initial objective of physiotherapy
(when needed) is to decrease the inflammation. Later
the small muscles of the foot will be strengthened to support
the weakened plantar fascia.
Cortisone
A cortisone injection is usually quite
beneficial if the above have not solved the problem. It
is a local injection and it is very safe in this area.
Surgery
Surgery is occasionally required for plantar
fascitis. The tension on the plantar fascia is released,
and the spur may be excised.
Risks
Risks include skin breakdown, infection,
slow healing, nerve or blood vessel damage, blood clots, and
other complications. Discuss these with our team prior
to your surgery and make sure you understand them.
Sports
Plantar fascitis can be aggravated by all
weight-bearing sports. Repetitive foot landing, such
as occurs in running and jogging, will aggravate the problem. When
the problem is severe the best sports are ones which are non-weight-bearing
(i.e. swimming, cycling). Go back into other sports slowly. If
you have a lot of pain either during the activity or following
morning, you are doing too much.
Shoes
It is possible for shoes to cause the problem. You
may need different or new shoes. A knowledgeable salesperson
can be invaluable.
Exercise
The following exercises are designed to
strengthen the small muscles of the foot to help support the
damaged area. If performed regularly, they will help
prevent re-injury.
Towel Curls
Place a towel on the floor. Curl
the towel toward you, using only the toes of your injured foot. Resistance
can be increased with a weight on the end of the towel. Repeat
20 times.
Shin Curls
Run your foot slowly up and down the shin
of your other leg as you try to grab the shin with your toes. Repeat
30 times. A similar exercise can be done by curling your
toes around a tin can.
Toe Grabs
Stand feet together. Rotate your
knees outward while attempting to grab the floor with your
toes using the muscles of your foot. Hold 10 seconds,
then relax. Repeat 20 times.
Stretches
A)
Lean against a wall with your back knee
locked. Press forward until a stretch is felt in your
calf muscle. Hold for 15 seconds.
B)
Then bend your knee until a stretch is
felt in your Achilles tendon. Hold a further 15 seconds. Repeat
3 times. You should feel a pull in your muscle and tendon,
but no pain.
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