Plantar Fascia

Plantar Fascia

The plantar fascia is a thick band of connective tissue stretching from the medial calcaneal tuberosity to the proximal phalanges. It is composed of three segments all arising from the calcaneus. The central band, which is the most important segment, provides static support to the longitudinal arch and acts as a dynamic shock absorber. During the gait cycle, upon heel contact the sub-talar joint supinates, at mid stance it pronates (shock absorption), before re-supination at the late stance phase.

Plantar Fasciitis is viewed as an overuse injury of the plantar fascia which causes disarray or degeneration of the plantar aporneurosis . The origin at the medial cancaneal tuberosity is the usually the site of abnormality. Jarde et al (2003), found degenerative changes in the plantar fascia with and without inflammation. Therefore the condition may be more representative of the term plantar fasciosis which implies a degeneration rather than an inflammation.

Risk Factors

• BMI >30Kg/m2
• Reduced ankle dorsi flexion
• Tight calf muscles
• Standing all day

Signs & Symptoms

Plantar fasciitis usually presents as medial heel pain which is worse on rising from bed in the morning, and goes away with activity only to reappear after activity. You may limp with their first few steps in the morning or after long periods of inactivity. In chronic cases prolonged weight bearing may also produce pain.

Physical Therapy Treatments

• Night splintig
• Calf stretching
• Plantar stretching
• Exercise perscription
• Orthotics – short term
• Manual therapy

The evidence for these various treatment varies greatly. In future posts I will highlight there levels of evidence.