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Plantar Fascitis & Heel Spurs

Plantar Fascitis simply means inflammation of the plantar fascia. Fascia is a thickened form of connective tissue that is found throughout the body attaching various structures together (such as bones, tendons, ligaments and muscles). The plantar fascia exists in the sole of the foot, and it may become overstretched or partially torn when it is subject to excessive stress. This may occur with excessive standing, walking, running and may be also affected by increased body weight or unsupportive shoes. Sometimes heel spurs (a bony outgrowth) may develop on the calcaneus (heel bone) where the plantar fascia attaches to. To understand this injury more fully, the anatomy must first be understood.

ANATOMY

The plantar fascia originates on the calcaneus (heel bone) and then spreads out like a sheet and divides into two layers; a superficial layer (meaning just between the skin and the subcutaneous fat) and a deep layer (between the superficial layer and the muscles in the sole of the foot). The superficial layer inserts into the subcutaneous tissue, while the deeper layer inserts into the metatarsals and phalangeals (bones of the toes). This shows how the deep layer is affected more when the toes are extended or bent upwards as in the "push-off" phase of walking or running. Other important structures that are sometimes affected along with the plantar fascia are the tibialis posterior muscle and some of the deep intrinsic foot muscles. These muscles and the tendon of tibialis posterior all run beneath the plantar fascia. This is why a flattened arch is often associated with plantar fascia as well as intrinsic foot muscle dysfunction.

FUNCTION

The plantar fascia helps support the arch, and helps make the foot stable during "push-off". These important functions work while standing and during movement respectively.

An analogy to demonstrate the first function: The bones of the feet form an arch, which can be likened to the arch of a bow, while the plantar fascia which attaches the heel to the toes can be likened to the bow-string. If the string is overstretched, then the bow loses some of it's arch, and if the bow is straightened, the string is over-stretched.

The second function of helping to stabilize the foot for "push-off" is done primarily by the deep layer of the plantar fascia. As the foot is loaded with weight at the start of "push-off", the toes bend up relative to the foot. This makes the plantar fascia taut and allows the foot to be used as a rigid lever. This function (called the Windlass-Effect) also helps prevent further injury to other structures within the foot.

INJURIES

Injuries to the plantar fascia occur with excessive force through the plantar fascia. Understanding the function of the plantar fascia, it can be seen how this can occur in the static situation (ie: standing), or during the dynamic situation (walking or running). Other factors include increased weight which simply increases the overall load, improper footwear which may not support the arch, repetition, overpronation (flat-feet) and poor biomechanics (movement patterns) during activity.

Heel spurs may occur in the above manner, and may also be the direct result of excessive force through the heel bone. As we age the specialized fat which pads the heel can thin out. This can predispose people to heel spurs as well as stress fractures.

Symptoms generally include sharp pain in the arch during the stressful activity or excessive standing. This pain may extend from the heel to the ball of the foot. Once injured, the pain is often worst in the morning, and then tends to decrease until later in the day when a stressful activity is started. Heel spurs tend create specific pain right at the heel, but these injuries may occur simultaneously.

PHYSIOTHERAPY TREATMENT

As each injury is unique with respect to the structures involved, the extent of damage, and the biomechanics of the individual, it is very difficult to discuss the physical therapy management fairly. General mamagement guidelines for soft tissue injuries during the early acute phase, go to the Injury Care page. It also mentions the various treatment choices that may be employed by your physical therapist.

The specific treatment should be based on a full assessment, which should include a detailed history, a full functional assessment of the injured area, a biomechanical analysis of the whole person (includes posture, movement patterns, etc...) and screening for more serious pathology.