Peak Points - Mechanical Foot Problems – Plantar fasciitis

With the foot being a weight bearing structure, the majority of symptomatic conditions (other than impact / trauma injuries) tend to be very much mechanical in nature. By far the more common mechanical condition encountered is Plantar fasciitis.

Why mechanical?

The overwhelming majority of symptoms are exaggerated with prolonged standing and weight bearing.

This enthesopathy of the plantar fascia often presents with pain through the medial plantar heel, typically when arising from bed in the morning or arising from prolonged periods of non weight bearing ie. sitting at the desk or in the car. The initial marked discomfort eases as the patient moves around or “warms up”. As the conditions progresses, less relief and more sustained pain is experienced.

Patients can also report an intermittent tearing pain through the arch of the foot with walking and running rather than localised heel pain.

Plantar fasciitis is generally regarded and an overuse injury. Symptoms can arise with:

• an increase in activity,
• commencement of a walking program
• badly worn or inappropriate footwear.
• pronated feet (“flat feet”) where the arch collapses and exaggerates mechanical stress to the plantar fascia. Pronated feet are predisposed to this condition.

Clinical Assessment

Pain is noted on palpation of the plantar-medial aspect of the calcaneus (Figure 1). Tenderness is also often noticed through the mid fascia. Dorsiflexion of the hallux and foot will reveal the prominence of the plantar fascia and enable effective palpation.

• Assessment of foot posture is important to identify the pronated foot. Drawing of a calcaneal bisection line on the posterior heel helps with assessment. Clinical signs include calcaneal eversion (Figure 2) and possible midfoot (navicular) bulge of the medial foot.
• Excessive medial wear of the shoe on the forefoot or medial deviation of the shoe when placed on a flat surface is also a good clinical indicator.
• It is useful to watch the patient walk a few steps as sometimes statically their foot posture appears neutral, and collapse of the medial foot only occurs with movement.

Treatment

Treatment is aimed at reducing inflammation and removing mechanical irritation.

Initially self management in the form of ice, calf stretching (Figure 3) and massage is very useful. Massage may be done by rolling a can or tennis ball under the arch. Correct footwear that provides the appropriate balance of cushioning and support is also very important. Avoidance of being barefoot is indicated in the acute stage.

Initial mechanical correction can be effectively achieved with taping techniques such as the low dye taping, to help support the plantar fascia. The majority of symptoms usually resolve over a 4-6 week period.

Further treatment may include NSAIDs and possible cortisone injection. If effective relief is achieved with taping and ongoing support is required, orthotics are indicated to provide sustained support on a convenient long term basis. As such - strapping provides not only immediate relief, but is a very good diagnostic tool to identify those that will benefit from orthotic therapy.

Podiatry uses a combined approach for the treatment of Plantar fasciitis and interaction with the patient's GP to ensure best outcomes.

For more information or assistance please contact Darryn Sargant and Don Hulme at PEAK PODIATRY SUBIACO 9388 9999 • admin@peakpodiatry.com.au • www.peakpodiatry.com.au

Darryn Sargant and Don Hulme
Peak Podiatry Subiaco
211 Nicholson Road
SUBIACO
9388 9999

Darryn Sargant is a sports podiatrist with ten years experience. Darryn has treated many elite and general athletes in many codes including triathlon and running. Darryn was a medical team member for the Sydney 2000 Olympic Games.