Plantar Fascitis

Plantar fascitis ( aka heel spurs )is one of the most troublesome of all sports injuries because it can be very difficult for the body to heal itself. Chronic plantar fascitis creates pain for months, and without proper treatment may persist indefinitely. Some patients plantar fascitis discomfort may vanish for several weeks, then one morning the patient is greated by the sharp pain in the heel upon getting out of bed.

Studies suggest that approximately 10% of individuals who see a doctor for plantar fascitis have the problem for more than a year. Chronics plantar fascitis is defined as plantar fascitis symptoms persisting for 6 months or more.

The plantar fascia is actually a thick, fibrous band ofconnective tissue which beginning at the heel bone and running along the bottom of the foot that attaches to the base of each of the toes. A rather resilient structure, the plantar fascia performs many critical functions while running and walking. The plantar fascia stabilises the metatarsal joints (connecting the long bones of the foot to the toes ) during impact with the ground, absorbing shock for the foot and entire leg. The fascia also helps your foot prepare for the "take-off' phase of the running gait cycle.

Although the fascia is composed of strong "cables" of connective tissue called collagen fibres, it can be easily injured. An estimated 10% of all running injuries are inflammations of the fascia, an incidence rate which in the U.S. would produce more than 200,000 cases of plantar fascitis per year, just from the running population. Plantar fascitis is seen in basketball players, tennis, volleyball, step-aerobics participants, and dancers may suffer from plantar problems. Interesting, many sufferers are non-athletic people who suddenly become active after a long period of idleness or that spend a lot of time on their feet. Many cases of plantar fascitis appear in 'couch potatoes' and 'weekend warriors' shortly after they've made their first trip around their property with a lawn mower, paint brush, or garden rake.

What causes plantar fascitis?

What casues the fascia get inflammed? Although the plantar fascia is a fairly rugged structure, the plantar fascia can only stretch to 102% of its length without tearing. This puts a tremendous load in the fascia every time the foot hits the ground whether running, walking, jumping, skipping, etc. While running the fascia is subjected to a force equal to almost three times body weight which must be absorbed by the foot 90 times a minute. ("Anatomy and Biomechanics of the Hindfoot," Clinical Orthopedics, vol. 177, pp. 9-I5, 1983). With that type of stress it's not surprising that plantar fascitis occurs so frequently. The fascia damage and pain often tends to occur near the heel because this is where stress on the connective tissue fibres is greatest, it also happens be the weakest point of the fascia.

The location of the pain near the heal is one reason why plantar fascitis is often associated with 'heel spurs'. Those 'spurs' are simply calcium deposited at the site where the fascia suffers most damage. This is a very common body response to stress. The heel agitations also explain why the clinical manifestation of plantar fascitis is usually strong discomfort at the bottom of the heel bone. Individuals suffering from plantar fascitis will often feel a sharp knife-like pain at the "medial tubercle" of the calcaneus (heel bone). This happens to be the exact location of the origin of the inside part of the plantar fascia. Swelling may occur just in front of the heel bone, and pain can radiate along the whole longitudinal arch of the foot.

Who gets plantar fascitis?

Why do only some people get plantar fascitis? Research suggests that plantar fascitis is often associated with a change in activity (like a sudden increase in the volume or intensity of training or a simple expansion of the total time you spend on your feet). Worn our shoe, poorly manufactured shoes, also seem to increase the risk especially when running on pavement. Individuals with flat feet or high arches are also though to be at greater risk of plantar fascitis. A sudden increase in hill training may also spark a bout of plantar fascitis. Pregnant women are also prone to suffereing from this heel pain. The heavier and individual is, the greater the greater the risk for plantar fascitis. A recent study determined that 77% of its sample of 411 plantar fascitis (heel spurs) patients were overweight. Another study found that 23% of overweight women had plantar fascitis (heel spurs) compared to 8% of the normal body-weight group. Excessive body mass simply places undue stress on the plantar fascia overstretching it with each "thud" of the foot on the ground. Women appear to be particularly prone to fascia injury. The best guess is that women have a lower center of gravity and this increase the stess in the foot as it pushes off the ground.

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