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Plantar fasciitis, a common overuse injury, describes pain in the region of the heel and sole of the foot This often causing pain at the insertion of the plantar flexion muscles at the ball of the foot in more advance/severe cases . Most patients with this condition describe pain when they first let their foot hit the floor in the morning. The most common factors contributing to this condition include lack of flexibility, poor foot mechanics, muscle weakness and intense training schedules . It accounts for about 10% of running injuries. Treatment involves decreasing inflammation, correcting foot mechanics and altering exercise routines and rehabilitative exercise.
The word fascia refers to a casing type tissue which surrounds a muscle much like the casing that is found around a sausage. The plantar fascia runs from the heel bone (calcaneus) to the base of the toes. It helps to maintain the inside (medial) arch of the foot. It also acts as part of the shock-absorbing mechanism of the foot and stabilizes the foot during toe-off. During running, the force generated with each heel strike is two to four times body weight and occurs 800 to 2000 times per mile. Overuse can cause overload at the insertion of the plantar fascia at the calcaneus. Over time this trauma then cause acute inflammation and if sustained causes a chronic condition that often causes a spur to form at the heel visualized on an x-ray.
Most often in my practice patients with plantar fasciitis have poor foot biomechanics which can easily start with even a mild sprained ankle. I see a lot of people who have undertaken a rigorous training schedule that has precipitated the pain and less commonly someone who has had trauma to the leg or ankle causing poor mechanics. There is another factor that needs to be examined with some patients which includes their purine metabolism for those that suffer from conditions such as gout. Patient with gout become more complicated because of the deposition of crystalline structures in the foot due to a dysfunction in their body to metabolize certain properties.
Treatment of plantar fasciitis is multi-faceted and can be complex. First, complete rest or relative rest must be considered. If there is constant pain with any weight-bearing exercise, rest from exercise for about one week should be considered. If weight-bearing activity causes some pain, then a non-weight- bearing activity like water running, bike, rowing machine etc. Ice is a must and is best administered by rolling your foot over a frozen water bottle. Physical therapy modalities like ultrasound or ultrasound combined with electrical stimulation can be used to speed healing.
Adhesions form in the sole of the foot in the plantar fascia, plantar aponeurosis and the intrinsic muscles. Other areas like the Achilles Tendon, muscles of the calf and front of the leg must be checked as well for adhesions. This scar tissue must be broken up to allow the tissue to heal properly. When the tissue tears, the first response in the body is an inflammation that may or may not cause significant swelling. The texture of the tissue changes and after the initial inflammation the tissue feels taut like a guitar string and bumpy like gravel. Have you ever kneaded bread dough or pottery clay and tried to get the lumps out to make it smooth? This is like what treating the injured tissue feels like. This "adhesion" or scar tissue must be broken up or kneaded away. Two techniques that break up these adhesions in the muscles are called Active Release Techniques® and Graston Technique. Through chiropractic adjustments we are able to restore the mechanics of the foot/feet once we are able to loosen and break up the adhesions in the fascia and muscles in the foot.
It is important to address this condition head on because far too often I see people who have one foot affected, which then leads to both, due to the length of time they have compensated for the initial foot hurting! The sooner you can address it the quicker it is the resolve in most cases!
The key we have found in our clinic that is often not addressed elsewhere is the insertions of the deep flexors of the lower leg on the back side of the tibia. These insertion points are often overlooked and therefore causing the condition to return or not completely resolve.
This condition cannot be resolved using anti-inflammatory drugs like ibuprofen (Advil, Motrin, Nuprin), naproxen (Aleve), Celebrex or Vioxx. These medications can help with the initial pain & inflammation, but they can disrupt and prevent proper healing of the muscle tissue and can end up causing more damage long term.
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