Chronic Foot Conditions
Usually your injured fascia will be healed via fibroblastic activity. They’ll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area.
Osetoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs. This scenario is most common in the traction type injury.How Do You Treat Heel Spurs?
Treatment or heel spurs is almost identical to plantar fasciitis treatment. Your physiotherapist will select the most appropriate treatment modalities for you.
Pain reduction is the primary aim. This may include rest from aggravating activities, ice applications, gentle plantar fascia stretching, massage techniques, electrotherapy, taping.
Useful products include soft orthotics (overpronators / traction type pain) or heel cups (compression pain). A soft orthotic when used in conjunction with a stretching program is more likely to improve acute symptoms than a custom polypropylene orthotic device. Often it is poorly designed footwear that can predispose to the injury.
Ice and a home tens unit can often speed up recovery and reduce the need for drugs.
Ultimately, biomechanical correction is the aim. Foot intrinsic muscle strengthening (including tibialis posterior and peroneus longus) and calf (gastrocnemius and soleus) stretches are almost always required.
Cases of moderate to severe biomechanical deformity should be referred for physiotherapy or podiatric assessment to prevent chronic recurrence. NSAID’s and corticosteroid injection is most effective when combined with biomechanical correction.
While traditional methods alone are ultimately effective, iontophoresis in addition to traditional modalities has shown a quicker reduction in pain.
Extracorpeal shockwave therapy is being increasingly used for plantar fasciitis and heel spurs , but limited evidence supports its use.
Mechanical treatment that involves taping and orthoses has been shown to be more effective than either anti-inflammatories or accommodative modalities.What Happens If You Do Nothing?
Left untreated, heel spurs grow larger and usually become excessively painful. Limping is very common.
Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis.What Causes Plantar Fasciitis?
Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods.
They are either traction or compression injuries.
Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles.
It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.Traction Plantar Fasciitis
Plantar fasciitis symptoms are usually exacerbated via “traction” (or stretching) forces on the plantar fascia. In simple terms, you plantar fascia is repeatedly overstretched. The most common reason for the over-stretching are an elongated arch due to either poor foot biomechanics (ex. over-pronation) or weakness of your foot arch muscles.
The location of plantar fasciitis pain will be further under your arch than under your heel, which is more likely to be a fat pad contusion if a single trauma caused your pain.
The compression type plantar fasciitis can confused with a fat pad contusion that is often described as a “stone bruise”.Symptoms
You’ll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting.
Your heel pain will be worse with the first steps and improves with activity as it warms up.How Does Plantar Fasciitis Progress?
As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines:
• No Heel Pain – Normal!
• Heel pain after exercise.
• Heel pain before and after exercise.
• Heel pain before, during and after exercise.
• Heel pain all the time. Including at rest!
This symptom progression is consistent with the four stages of a typical overuse injury Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone it is known as heel spurs,which have a longer rehabilitation period.
How is Plantar Fasciitis Diagnosed?
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination.
After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts.
X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur.
Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.
Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Risk Factors for Plantar Fasciitis
You are more likely to develop plantar fasciitis if you are:
Active – Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. Running, ballet dancing and aerobics.
Overweight – Carrying around extra weight increases the strain and stress on your plantar fascia.
Pregnant – The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation.
On your feet – Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses.
Flat Feet or High Foot Arches – Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.
Middle-Aged or Older – With ageing the arch of your foot may begin to sag – putting extra stress on the plantar fascia.
Wearing shoes with poor support.
Have weak foot arch muscles – Muscle fatigue allows your plantar fascia to overstress and cause injury.
Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
Diabetes. Although doctors don’t know why, plantar fasciitis occurs more often in people with diabetes.
Plantar Fasciitis Treatment
The good news is that plantar fasciitis is reversible and very successfully treated. About 90 percent of people with plantar fasciitis improve significantly within two months of initial treatment.
If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). Cortisone injections have been shown to have short-term benefits but they actually retard your progress in the medium to long-term, which usually means that you will suffer recurrent bouts for longer.
Due to poor foot biomechanics being the primary cause of your plantar fasciitis it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development of a heel spur.
Your physiotherapist is an expert in foot assessment and its dynamic bio-mechanical correction.
Researchers have concluded that there are essentially 8 stages that need to be covered to effectively rehabilitate plantar fasciitis and prevent recurrence. These are:
Phase 1 – Early Injury Protection: Pain Relief & Anti-inflammatory Tips
As with most soft tissue injuries the initial treatment is Rest, Ice, and Protection.
In the early phase you’ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking foot postures. This means that you should stop doing any movement or activity that provoked your foot pain in the first place.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. A frozen water bottle can provide you with a ice foot roller that can simultaneously provide you with some gentle plantar fascia massage.
Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. To support and protect your plantar fascia, you may need to be wear a plantar fascia brace , heel cups or have your foot taped to provide pain relief. As mentioned earlier, the cause of your plantar fasciitis will determine what works best for you. Your physiotherapist will guide you.
Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff joints, massage, electrotherapy, acupuncture or dry needling to assist you during this pain-full phase.
Phase 2: Regain Full Range of Motion
If you protect your injured plantar fascia appropriately the injured tissues will heal. Inflammed structures will settle when protected from additional damage, which can help you avoid long-standing degenerative changes.
Plantar fasciitis may take from several weeks (through to many months) to heal while we await Mother Nature to form and mature the new scar tissue, which takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that may become lumpy or potentially re-tear in the future. It is important to lengthen and orientate your healing scar tissue via massage, gentle stretches, and light active exercises.
In most cases, your physiotherapist will identify stiff joints within your foot and ankle complex that they will need to loosen to help you avoid plantar fascia overstress.A sign that you may have a stiff ankle joint can be a limited range of ankle bend during a squat manoeuvre. Your physiotherapist will guide you.
Phase 3: Restore Foot Arch Muscle Control
Your foot arch is dynamically controlled via important foot arch muscles, which be weak or have poor endurance. These foot muscles have a vital role as the main dynamically stable base for your foot and prevent excessive loading through your plantar fascia.
Any deficiencies will be an important component of your rehabilitation. Your physiotherapist is an expert in the assessment and correction of your dynamic foot control. They will be able to help you to correct your normal foot biomechanics and provide you with foot stabilization exercises if necessary.
Phase 4: Restore Normal Calf & Leg Muscle Control
You may find it difficult to comprehend, but all of your leg (calf, thigh and hip) muscles play an important role in controlling your foot arch and its normal function.are very important in the rehabilitation of shoulder pain and injury. Your physiotherapist will assess your leg muscle function and provide you with the necessary treatment or exercises as required.
Phase 5: Restore Normal Foot Biomechanics
Your foot biomechanics are the main predisposing factor to plantar fasciitis. After a biomechanical assessment you may be recommended an orthotic.
Phase 6: Improve Your Running and Landing Technique
If your plantar fasciitis has been caused by sport it is usually during repetitive activities, which place enormous forces on your plantar fascia.
In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with technique correction and exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.
Phase 7: Return to Sport or Work
Depending on the demands of your chosen sport or your job, you will require specific sport-specific or work-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport or employment.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work. Work-related injuries will often require a discussion between your doctor, rehabilitation counsellor or employer.
Phase 8: Footwear Analysis
Often it is poorly designed footwear that can predispose to the injury. Seek the professional advice of your healthcare practitioner.
Patients usually present with a sudden onset of pain, often likened to an electric shock. Numbness is also frequently present in the two affected toes.The diagnosis is essentially clinical, but can be confirmed through an ultrasound, or an MRI scan.
Initial treatment is conservative, but in severe cases where surgical intervention is necessary the neuroma is removed.
The most common source of Ball of Foot pain is metatarsalgia. The term is derived from the medical term metatarsals (long bones of the foot) and algos (the Greek word meaning pain).
The metatarsal bones are designed to equally share the weight of a person during walking and daily activities. When this delicate balance between bones is disrupted, the result can be mild to intense foot pain. The term metatarsalgia refers to the number of problems people can experience in this area.Causes of Metatarsalgia
The causes of metatarsalgia pain can be attributed to a number of factors, from bone abnormalities to systemic diseases such as diabetes.
The most common cause is an alteraton of the posture in the long bones (metatarsals) of the foot. These bones absorb the weight during walking, and if one of the bones falls down through weakness or lack of support, is abnormally long or fractured from stress, it will create dysfunction among all bones.
Other causes include:
• An enlarged metatarsal head.
• Arthritis or any degenerative disease of the joints.
• Systemic conditions such as diabetes, which can cause nerve-type pain in the foot.
• Calluses or skin lesions that cause the weight on the foot to be unevenly distributed.
• Ageing, which tends to thin out or shift the fatty tissue of the foot pad.
• Sports that place tremendous pounding on the ball of the foot, like jogging.
• Ill-fitting shoes that put pressure on the bones of the feet.
• Shoes with small toe boxes that cramp your toes.
Symptoms of Metatarsalgia
• The main symptom of metatarsalgia is pain in the ball of the foot, and is most pronounced when walking (especially on your toes) or engaging in sports. Since the foot supports the body in all its activities, chronic pain in the ball of the foot impacts the ability to perform ordinary tasks.
•Discomfort when wearing shoes and socks.
•Pain during activities where impact is applied to the foot, such as running.
Relief and Prevention of Metatarsalgia
Treatment of metatarsalgia depends on the cause. Here are a few suggestions to help alleviate the pain and discomfort associated with this condition:
Taking a good look at the shoes you wear is the first step in eliminating and preventing the painful condition of Metatarsalgia. The objective is to find appropriate footwear that distributes the weight and pressure evenly across the foot, rather than concentrates it in the toes and ball of the foot. Fashion designers are very inconsiderate of people suffering Metatarsalgia.
Footwear Orthotics or Metatarsalgia Accessories
Metatarsal domes or pads that help se parate the foot bones and relieve pressure on the metatarsals.
Supportive foot arch orthotics and insoles to prevent the abnormal collapsing of the arch.
Corrective Metatarsalgia Exercises
CARE Institute/Sabga physiotherapists are trained in the application of dynamic corrective foot posture exercises. The fantastic benefit of these exercises is that you’ll actually correct the problem via your own muscles and don’t need to wear shoes with props or orthotics to solve your problem. Our foot muscles are designed to work effectively, they’ve just forgetten the basics, especially if you’ve worn shoes to support your feet most of your life. The good news is that they can be retrained successfully within days or weeks.
Your physiotherapist will also inspect other reasons for your foot collapsing, such as muscle tightness or referred pain from your back.
Surgery for Metatarsalgia
When metatarsalgia does not respond to these treatments, surgical solutions may be required. Consult your physiotherapist or a podiatrist for further options and considerations related to metatarsalgia.
For any chronic foot condition, contact us for an assessment