Plantar Fasciitis

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Everything You Need to Know About Plantar Fasciitis Most athletes whether they’re serious about training or occasionally take part in sports will experience their share of injuries. Runners especially suffer from foot injuries. Perhaps none are more troubling than plantar fasciitis. Although this is a fairly common foot injury affecting approximately 10 percent of all those who run the real cause of this condition is still not entirely agreed upon and treatment remains difficult. The following information describes what plantar fasciitis is how the condition can be diagnosed and ways to relieve the pain. What is Plantar Fasciitis Plantar fasciitis occurs when the support system along the bottom of the foot becomes irritated. This will result in pain at the very bottom of the foot and heel. Professionals are not in agreement on whether the condition is caused by ongoing inflammation or continued trauma that brings about weakened tissues and chronic degeneration. Many people who develop this condition spend long hours on their feet whether it’s because of their occupation or participation in athletics. When an individual is running the plantar fascia works in conjunction with the Achilles tendon. Due to the strong attachment at the base of the toe the plantar fascia will help stabilize the inner part of the foot. Plantar fasciitis will usually be painful when the foot pushes off while running but not when there is initial contact. This makes this injury different from other heel conditions such as stress fractures and bone spurs. What Causes Plantar Fasciitis This condition may be the result of a combination of factors some of which include continually running hill workouts or even tight calves. Several specialists believe however that the biggest cause is fallen arches.

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This can happen when flat-footed runners excessively lower their arches and thus the tension increases in the plantar fascia. This in turn overloads the attachment in the plantar fascia onto the heal bone. Over the course of time the plantar fascia being subjected to repeated pulling is believed to lead to inflammation and chronic pain where the plantar fascia connects to the heel. How is Plantar Fasciitis Diagnosed There are different ways for how plantar fasciitis is diagnosed. One way to tell if you’re suffering from plantar fasciitis as opposed to a stress fracture or heel spur is to walk on your toes. Stress fractures and spurs in the heel will normally feel better when you’re on your toes. Plantar fasciitis will usually cause more discomfort when you put weight on your toes. Once a person has been diagnosed with plantar fasciitis it’s important to take precautions so the condition does not worsen while treatment is being sought. Since the plantar fascia receives the most stress during the propulsive time while running those with plantar fasciitis should not make initial ground contact with their forefoot or the middle of their foot. A striking pattern with the heel first is the best contact point. A runner should also avoid hill running until this type of injury has been resolved. How to Relieve Plantar Fasciitis Pain While icing and using anti-inflammatories can temporarily relieve the pain of plantar fasciitis it is not a permanent treatment. The following provides several examples of ​treatment options for plantar fasciitis ​. 1 Individuals who complain of excessive pain during the morning hours have had good results using night braces. Soft tissues that are immobile and in a lengthened position usually will heal more quickly. It’s sometimes recommended to place a small cloth that is rolled up under the toes while the night brace is on. The cloth should be placed in a way so it does not add to any discomfort. 2 Physical Medicine and Rehabilitation recently published a review article that stated that the best treatment involves stretching the calf and the plantar fascia itself. The article also suggests treatment arch support. Foot orthotics are sometimes recommended as treatment for these types of foot conditions. The research suggested that arch support worked best when combined with a certain amount of stretching. 3 A study published in the British Journal of Sports Medicine in 2013 states that foot core strengthening can be used for treating plantar fasciitis. The article goes on to say that while using arch support can be helpful during the initial phase of the injury it should be replaced as quickly as possible with a strengthening routine. 4 Placing angled wedges under the inner heel is another way to manage plantar fasciitis. Research at the Orthopedic Bioengineering Research Laboratory located in Illinois has shown

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that an angled wedge under the inner heel significantly reduced the strain when the full body weight was placed on the foot. These types of wedges are available that can be put beneath the insole of a shoe. 5 For those who don’t respond to any of the previous treatment methods some have had success with extracorporeal shock wave therapy. This treatment can be completed in an office setting by sports podiatrists. It is believed to stimulate repair of the damaged area and bring about faster healing. Most individuals who suffer from plantar fasciitis however normally respond well to less expensive treatments that can be completed at home. What Types of Treatment Have Been Proven Ineffective Some people might want to try corticosteroid injections to relieve the pain from plantar fasciitis. These types of injections should be avoided since this will increase the chance of rupturing the plantar fascia or even causing damage to the protective fat pad on the heel. Surgical intervention should always be used as an absolute last resort. This is because the cutting of the plantar fascia will result in the slow destruction of the medial arch. Because the plantar fascia plays an important role in stabilizing the arch if it is surgically cut the arch will eventually collapse. Instead of using injections or cutting the plantar fascia a better solution is to try deep tissue massage to both the calf and the arch. How to Handle Your Diagnosis of Plantar Fasciitis Many people often get up in the morning to excruciating pain in the bottom of the feet. Walking around makes it a little better so they believe it was nothing serious. They also don’t remember injuring their foot so expect it is gone for good. However the same thing happens every morning until one day the heel pain doesn’t go away as quickly. This common injury is known as plantar fasciitis and it can be easy to treat if you get treatment early on. This may

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include plantar fasciitis exercises or plantar fasciitis shoes. If you wait to go to the doctor the injury will take much longer to heal. Plantar fasciitis pronounced plan-ter fash-eye-tis is something to take seriously but the heel pain can be treated easily. What is Plantar Fasciitis The bottom of your foot is lined with a large band of connective tissues. This band called the plantar fascia actually runs from the heel to the bottom of the toes. As a support for your arch it is similar to a shock absorber as it absorbs the impact of walking or running. If you are exercising or running and the tension in the plantar fasciitis is great small tears can happen which result in pain inflammation and irritation. If you’ve noticed your feet throbbing after a workout or after you have been on them all day this is likely to be the cause. Some people state that it feels like someone is stabbing them in the arch of the foot. Once people know the answer to the question of what is plantar fasciitis they often recognize the symptoms immediately. As the connective tissue starts to heal while you are sleeping putting weight on it in the morning can cause the pain all over again. The Cause and Risk of Plantar Fasciitis There are many ​causes of plantar fasciitis ​. If you suddenly start working a job where you are on your feet all day you have flat feet or you don’t wear shoes that fit properly you are putting yourself at risk. Other causes of plantar fasciitis include: Your Age While plantar fasciitis does not discriminate on age it is more common for those between to ages of 40 and 60 to be diagnosed with it. Type of Exercise There are also certain types of exercises that put people more at risk for it including running ballet dancing and aerobic dances. As these cause more pressure to be placed on the heel they often contribute to more tears of the plantar fascia. Not Stretching Prior to Exercising Stretching before you exercise will not just lead to pulled hamstrings it can also cause your muscles to put more tension on the plantar fascia which puts you at further risk of injury. Proper Foot Technique If you walk and your foot turns in have a strange gait or unusual stride you may find this can play a role in how much tension is placed on the plantar fascia.

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Your Weight If you are obese or you are carrying around some extra weight you will find that it will put extra tension on your feet. This of course puts you at risk for plantar fasciitis. Treatment for Plantar Fasciitis No matter what caused this excruciating heel pain the one thing you need to do is fix it. It will generally not go away without the proper treatment. In fact the majority of those who suffer from plantar fasciitis find proper treatment relieves them of symptoms within six weeks and as you will read later may include special plantar fasciitis exercises. Which treatment is right depends on the situation as there is not one particular treatment method that will work for everyone. It is simply a matter of figuring out which one is right for your own feet. Stretching: A common treatment for plantar fasciitis is stretching the lower extremities throughout the day. One method of doing this is to use a doorframe. Put your heel close to the frame with the ball of your foot on it. While you hang on lean in and bed your knee. Holding this for thirty seconds will help stretch your muscles. You may also trying sitting down on the floor and stretch your legs in front. A towel should be wrapped around the foot. By pulling on the towel and holding for thirty seconds you can stretch the foot and prevent more injuries. Both of these exercises should be repeated several times in a session. Ice Application: The inflammation associated with plantar fasciitis is no different than that of other injuries. For treatment of plantar fasciitis you can freeze water in a water bottle and place it on its side on the floor. Use your injured foot to roll the bottle back and forth several times a day. You will want to do this for about ten minutes each session. Foot Massage: While the bottle of frozen water will massage your foot you can also use a tennis ball to massage the area. This can be done at any time during the day and again it should be done several times a day. Anti-inflammatory Medication: If you have injured your plantar fascia you can use several over-the-counter medications to help with the inflammation including Iboprofen and Naproxin. Put Your Feet Up: When you have plantar fasciitis it is important to take the time to get off your feet or cut back on whatever is causing it to happen. If you are an avid exerciser you will find some alternative exercises below that will still allow your feet to get some rest. Plantar Fasciitis Shoes: You may also wish to try some new shoes on that will provide your feet with more support. Many people experience heel pain simply because their shoes do not fit properly and plantar fasciitis shoes that have support can help. You may also wish to purchase insoles for your shoes that will give you the extra arch support you need to keep yourself healthy. Exercising with a Plantar Fasciitis Diagnosis

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Many people still exercise with a diagnosis of plantar fasciitis but they do have to adjust the workouts to accommodate the problem. If you choose to continue exercising you must be sure that your workouts are not contributing to the issues. Some of the plantar fasciitis exercises to try when you have plantar fasciitis include: swimming and water aerobics lifting weights yoga elliptical and rowing machines mat Pilates and cycling while wearing hard surface shoes. There are also some exercises that you will want to avoid until your plantar fascia is healed. These include: running or jogging jumping bouncing and step-type aerobics. You will also want to avoid long walks whether for fitness or enjoyment and going barefoot. Wear shoes that always provide your feet with support. If you find a treatment for plantar fasciitis works for you continue with it as long as you have symptoms. You may find that physical therapy or custom orthotics is necessary. Plantar Fasciitis Treatment Introduction Plantar fasciitis is a thickening and degeneration of the tissue connecting heel and toes on the bottom of the foot. Plantar fasciitis is the most common musculoskeletal condition occurring in men. Roughly two million Americans have undergone treatment of plantar fasciitis. The old name for plantar fasciitis is a heel spur and is as obsolete as notion that the plantar fascia gets inflamed during the process of disease. The most correct scientific name for plantar fasciitis is plantar fasciopathy because it describes the problem from the pathological perspective. The plantar fascia PF is a tendon-like band of tissue that begins at the heel bone calcaneus and runs along the bottom of the foot inserting itself into the transverse ligaments of the metatarsus five long bones in the foot located between the toes and tarsal bones. The distal end of PF joins the metatarsophalangeal joints it divides into five heads which branch out into a delta and continues onward to form fibrous sheaths that assist in holding the toes in place. Inserted into and surrounding the plantar fascia are small plantar nerves that register and mediate our position in space during walking standing and moving. Unfortunately these receptors are also richly pain-innervated fibers as well. The plantar fascia tissue is comprised of three distinct components: a medial component a central component plantar aponeurosis and a lateral component of which the central portion is the largest and strongest and therefore most susceptible

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to injury. The plantar fascia works to provide tension and support throughout the arch of the foot operating like a tension bridge to give both static support and shock absorption so that the body does not suffer from the tremendous pressure exerted when the foot collides with the ground. Plantar fascia also provides slinky like acceleration to the foot by actively or passively shortening the distance from the heel to toes thereby increasing the arch in attempt to create the fulcrum within the foot for propulsion during different phases of the human gate. According to some studies the plantar fascia carries as much as 14 percent of the total load of the foot. Rupture of the plantar fascia may result in a decrease of arch stiffness and a collapse of the longitudinal arch. Causes and Symptoms Proper treatment for plantar fasciitis begins with understanding where it came from and how the patient acquired it. Because the heel is such a pivotal and vulnerable part of the body plantar fasciitis has a variety of different causes. Because the plantar fascia is like a rubber band loosening and contracting as the body moves plantar fasciitis may occur from an excess of exercise or other strenuous physical activity. This is why athletes and runners are so susceptible to it. Excessive running or jumping places pressure on the foot’s soft tissues that can lead to tears and inflammation. Athletes who suddenly increase the difficulty of their exercise routines may also damage their feet because the body has not adjusted to the pressure suddenly being inflicted on it. Plantar fasciitis may also result from prolonged exposure to shoes that don’t fit properly or fail to support the weight of the body. Walking or running in these shoes may create an imbalance of weight distribution in which one foot is doing more of the heavy lifting than another thereby placing huge amounts of force on the ligament of the plantar fascia. Wearing high-heeled shoes or boots may lead to plantar fasciitis over time. Having an abnormal gait or posture may cause the tissues to stretch abnormally resulting in tears and inflammation. Overweight and pregnant women are also vulnerable for the same reasons. Hormonal changes that occur during pregnancy may cause ligaments to become more pliable putting women at risk for plantar fasciitis.

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The pain of plantar fasciitis is typically caused by collagen degeneration at the origin of the plantar fascia in the calcaneus because of tears in the plantar fascia that overwhelm the body’s self-repair mechanisms. Patients undergoing treatment of plantar fasciitis will often complain of a burning or stabbing in the foot that’s especially prominent when they awaken in the morning. The fascia ligament tightens at night when the body is at rest lessening pain but when we get out of bed it becomes taut and sends pain shooting throughout the body. The pain usually lessens as the tissue re-adjusts but the condition may worsen with prolonged physical activity including sitting or standing. MISCONCEPTION ABOUT PLANTAR FASCIITIS The two most common misconceptions about plantar fasciitis is that stretching cures plantar fasciitis. Stretching during initial stage of plantar fasciitis is actually contraindicated. The next misconception is steroid injections. More than one steroid injection is proven to damage plantar fascia and worsen the condition by thinning plantar fat pad. The next misconception about plantar fasciitis is that most significant cause of plantar fasciitis is excessive pronation. The one single causative biomechanical reason of plantar fasciitis is the malfunctioned propulsion. DIAGNOSIS In the experience of the author which correlates with latest research plantar fasciitis should not be diagnosed solely on the grounds clinical evaluation as any physician who treats a large number of patients with heel pain and uses diagnostic ultrasonography can tell you how many patients are treated for non existent plantar fasciitis. Although high resolution ultrasonography is preferable to MRI both modalities are quite good for proper diagnosis. The next stage in diagnosis is biomechanical analysis as radiology only shows us the structure not the function. The video gait analysis combined with pressure analysis is the gold standard for evaluation of gait mechanics. Treatment of Plantar Fasciitis What is the best treatment for plantar fasciitis It really depends on the needs of the patient. Plantar fasciitis is frequently misdiagnosed. Unless proven by diagnostic

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ultrasonography or MRI heel pain should not be quoted as plantar fasciitis as there are many other causes of heel pain. Even true severe chronic plantar fasciitis can be treated non-surgically with a combination of gait specific physical therapy and conventional methods such as orthotic inserts and extra-corporeal shockwave therapy ESWT. Patients often confuse home management of PF with treatment. Stretches are a good supportive measure against plantar fasciitis only in the chronic stage. Initially stretching should be avoided. The standing calf stretch another physician-approved plantar fasciitis exercise may be undertaken any time during the day. The patient faces and places his or her hands against a wall at eye level. Then placing the injured leg behind him and the un-injured leg in front with the heel of the injured leg resting on the floor he makes a slight eversion inward turn of the foot and slowly leans into the wall until the back of the calf stretches slightly. Hold for 15 to 30 seconds repeat three times a session and perform as many sessions throughout the day as needed. As simple as it sounds self-massage is a proven and effective treatment for plantar fasciitis. The patient may massage his or her foot by placing a tennis ball or bottle of frozen water on the ground and gently rolling it under the foot for several minutes at a time. Using a tennis ball will help loosen the plantar fascia and make it less likely to be become irritated while using a frozen water bottle will help to keep inflammation at bay. It’s normal to feel some soreness when massaging the foot but stop if you begin to feel any pain and consult with your doctor. In addition to these a doctor may recommend the insertion of an orthotic a shoe insert custom-made for the patient in order to stabilize the foot. Elevating the foot by means of an orthotic prevents tearing and lengthening of the plantar fascia thereby relieving stress and loading while also preventing excessive pronation and correcting gait imbalances. However please note that foot stability can truly only come from within the foot and therefore orthotic is only recommended in the acute stage of disease. Due to the short strides creating excessive up-and-down motion in the body that places undue pressure on the muscles tendon and plantar fascia orthotics are especially helpful for slow runners who have injured themselves through tearing of the plantar fascia caused by asymmetrical running.

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The Extracorporeal Shockwave therapy is safe non-invasive therapy in which energy pulses are used to induce micro-trauma in the plantar fascia tissue that causes the body to repair those tissues. ESWT is recommended as an alternative for patients suffering from chronic plantar fasciitis for whom all the previous treatments have proven ineffective and who are considering surgery to remedy the symptoms and relieve suffering. How Do We Treat Plantar Fasciitis The good news is that for those staggering under the weight of chronic plantar fasciitis the New York DNR has a variety of treatment options available. We utilize diagnostic ultrasound to visualize the soft tissue around the calcaneus where most damage is inflicted. Our physical therapists assess the primary and contributing factors of heel pain to determine the origin of the condition and the best treatment for plantar fasciitis. We then provide an advanced heel therapy that mobilizes the joints of the foot and dynamically lengthens the fibrous tissues with gait specific maneuvers restoring them to their original function of supporting the foot’s weight. Our safe state-of-the-art non-invasive and comprehensive diagnostic methods include high-resolution diagnostic ultrasonography technological GAIT and running analysis to diagnose biomechanical faults during walking and running as well as excessive stress to the tissues in the foot. Our special gait specific rehabilitative exercises strengthen and elongate muscles of the whole kinetic chain hips feet and pelvis. Our Computer Assisted Rehabilitation Environment CAREN treats and re-stabilizes the patient’s locomotion and running posture balance re-training the nervous system in symmetrical weight-bearing and lessening the damage caused by excessive forces and excessive loading .If the integrity of the tendons or muscle tissues is compromised we combine rehabilitation with biological regenerative treatment making use of extra-corporeal shockwave therapy ESWT to regenerate damaged tendons and muscles. Visit our website ​ ​ to make an appointment today.

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