Apart from being a real pain to spell, Plantar Fasciitis is an extremely common, often mistreated foot condition that can cause slight pain or intense unbearable pain.
It can affect anyone, but mainly goes for:
1- People who use their feet regularly
2- People who are overweight
3- Females who have had really poor footwear
4- Excess foot users- like runners, store workers
5- Poor footwear users.
Now with Plantar Fasciitis there seems to be a lot of myth, a lot of false stories and many terms and conditions being muddled up.
To explain, we need a picture:
A picture shows a thousand words, and the above picture even though it is basic, shows what structures are affected and why.
The Fascia itself is a connective type of tissue. Not too elastic and it doesn't have a good blood supply. So it can not really adjust to the greatest of pressures, so it splits and it is hard to heal up- little blood supply.
The Achilles Tendon comes from your Gastrocnemius muscle (located on the back of your leg and is very prominent), a very powerful muscle which makes your foot go down- plantar flexes. The tendon inserts like a coil spring into your heel.
At the base of your heel bone the Fascia attaches from 2 lumps of bone. It then travels down the foot, and inserts into the bones of your toes.
The Plantar Fascia itself is used with ligaments and bones to create your arch.The best way to think of the Fascia is to look at a bow
The string being the Fascia- taut and powerful- but prone to problems. Nice musical bow picture below:
Now with all those different things affecting and joining in with the Fascia it is no wonder that it can get injured and plantar fasciitis can occur. And it usually does by a variety of ways.
1. If you have a Hypermobile foot then this tightens up the plantar fascia because the bones of the foot arrange themselves inwardly from the ankle.
Most people think pronation is a problem, but it is not. We need pronation, it is the excessive pronation that is the problem. Pronation occurs at a certain time when you walk, so your foot become "loose" to adapt to the terrain. If you have pronation at the wrong time or a longer time, then problem can build up.
The centre arrow shows the arch rolling in and pressure coming away from the centre of the fascia.
2. If you have a tight Gastrocnemius Muscle. then that pulls your foot down ever so slightly. This then has an affect of making the fascia tight because the heel bone is affected.
Also your foot needs about 10-20 degrees of up and down movement. If it doesn't get it (because the Gastroc muscle is too tight), it will find it from a mobile joint. This then in turn can set up conditions to make the joints hypermobile and put pressure on the fascia causing the above pain issues.
The above image shoes pulling up the Achilles tendon and pulling at the insertion of the fascia.
3. Too much fascia pulling on the bone causes a heel spur. Heel spurs
are not there initially and occur when the 2 bumps on the heel bone
respond to the excess force that the plantar fascia exerts on them. A
small bone projection occurs and is painful. As we get older a lot of us
will get heel spur that will not bother us. But having a tight gastroc muscle is the main cause of spurs.
A heel spur is secondary to the plantar fasciitis (picture taken from here):
4. Being overweight, Flat feet are not good for you because it squishes your foot down and causes tension onto the fascia. Most people who claim to have flat feet do not, it is not too common to see.
In the above picture there is direct "downward" pressure upon the fascia which causes again, pulling at the centre.
5. Overuse is a very common problem and occurs when there is already a problem rumbling around. Now with most foot problems they don't show themselves. It is only when we do something excessive, like play ball, excessive foot time at work then foot problems manifest into a problem.
6. Poor shoewear is another common problem. Usually seen in summer time, we have patient come to see us all the time with the same problem. It is all caused by super flat shoes with no stability or form.
The foot is out of shape, it has to overcompensate, it is doing things that it just should not do...and it gets injured. Now some women who wear high heels are very prone to this because their Gastroc muscle is slightly shorter because of "non-use" and when they go into full flats, it hurts.
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