Heel Pain and Plantar Fasciitis. Focuses mostly on Plantar Fasciitis.

1. HEEL PAIN AND
PLANTAR FASCIITIS
BY
JITHIN ABRAHAM

2. INTRODUCTION
The foot is really unique to human being. The structure of the foot allows
the foot to sustain large weight bearing stresses under a variety of surfaces and
activities that maximize stability and mobility.
Arches of the foot help in fast walking, running, jumping, weight bearing
and in providing upright posture.
Arches are supported by intrinsic and extrinsic muscles of the sole in
addition to ligaments, aponeurosis and shape of the bones.

3. Commonest of all causes
•Plantar fascitis
•Achilles tendinitis
•Achilles bursitis
•Calcanel spur
•Heel pad fat atrophy

4. PLANTAR FASCIA
• The plantar fascia is the thick connective tissue
which supports the arch on the bottom of the foot
• It runs from the tuberosity of the calcaneus
forward to the heads of the metatarsal bones
•The plantar fascia contributes to support
of arch of the foot
•The plantar fascia also has an important
role in dynamic function during gait

5. What is PLANTAR
FASCIITIS?
• Plantar fasciitis is a painful foot condition caused by
inflammation of insertion of the plantar fascia on
the medial process of the calcaneal tuberosity.
• This associated with
• Pain
• Swelling
• Warmth of the affected area
• Redness of the adjacent skin

6. AETIOLOGY
•Excessive pronation of the foot.
•Poor arch support in the shoe
•Flat foot
•Prolonged standing
•Fat pad atrophy
•Tight triceps surae
•Repetitive strength imbalances
•Over use may cause microtears and inflammation
•Congenital problems such as Pescavus and Pesplanus
•Obesity
•Reiters disease,Ankylosing spondylitis,Diffuse idiopathic
skeletal hyperostosis

8. RISK FACTORS
AGE:
Plantar fascitis is most common between the ages of 40 and 60.
SEX:
Women are more likely to develop plantar fasciitis when compared to men.
CERTAIN TYPES OF EXERCISE:
Activities that place a lot of stress on heel and tissue-such as long distance
running, ballet dancing and aerobics can contribute to an earlier onset of
plantar fascitis.
FAULTY FOOT MECHANICS:
Being flat-footed, having a high arch or even having an abnormal pattern of
walking can adversely affect the weight distribution when standing, adding
stress on the plantar fascia.
OBESITY:
Excess weight put extra stress on your plantar fascia.

9. RELEVANT ANATOMY
The os calcis is elevated anteriorly so
that during heel strike, the posterior
tubercle contacts the ground 1st and
transmits full body weight.
This make the calcaneum vulnerable
to trauma or micro trauma
The heel fat pad has many fat
globules enclosed by multiple
fibroelastic septa
And after 40 years this fat pad begin
to atrophy and degenerate

10. The plantar aponeurosis is an inelastic facia that arises from the os
calcis and is composed of three segments
Anteriomedial
tuberosity
Covers
undersurface
of abductor
haluucis

11. WINDLASS MECHANISM

12. Windlass mechanism of the plantar fascia
as the toes are dorsiflexed
Plantar fascia inserts through several slips
into the plantar plates of the
metatarsophalangeal joints, the flexor
tendon sheaths, and the bases of the
proximal phalanges of the digits, is under
constant traction as it is pulled distally
around the drum of the windlass
(metatarsal heads). This tightening
elevates the longitudinal arch, inverts the
hind foot and externally rotates the leg.
This mechanism is passive and depends
entirely on bony and ligamentous instabilty.

13. Pathomechanics of
Plantar fascia

14. •Excessive foot pronation:
• Excessive pronation or inward rolling of the foot also inhibits efficient
use of the windlass mechanism. This decreases shock absorption
through the plantar fascia which in turn increases the tension on the
plantar fascia.

15. •Tight calf muscles: Having tight calf muscles can cause
excessive foot pronation contributing to excessive foot mobility
which increases the level of stresses on the plantar fascia.

16. •High arched foot:
•A high arched foot lacks the normal joint mobility which reduces the
foot’s ability to absorb shock from the ground, thereby increasing
the stresses on the plantar fascia.

17. •Ill-fitting or worn out shoes:
•Wearing ill-fitting or worn out shoes may change the foot
biomechanics, causing undue strain on the plantar fascia.

18. •Excessive walking and running on hard surfaces: This
increases the shock transmitted to the plantar fascia,
increasing the strain on the plantar fascia.
•Overweight: Being overweight increases the level of stresses
applied to the fascia due to the added body weight on the foot,
increasing the strain on the plantar fascia.

19. INVESTIGATIONS
X-RAYS
•An X-ray may be taken to rule out a stress fracture of the heel bone
•X-rays of patient with heel pain sometimes reveal a calcification of the
plantar aponeurosis at the origin on the calcaneus, commonly referred to
as a heel spur
MRI:
Show thickening of plantar fascia
BONE SCAN:
It show increase uptake at the calcaneus
RHEUMATOLOGIC SCREENING:
It can be important to rule out inflammatory arthrides.

20. plantar aponeurosis as uniform bandlike
structure of low signal intensity.
thickening of central component of plantar
aponeurosis . Extensive edema infiltrates
perifascial soft tissue .

21. SPECIAL TEST
•Plantar fascitis have more tenderness in the plantar fascia when it is stretched
and less tenderness when the fascia is relaxed. The plantar fascitis test uses
this property to diagnose patients with plantar fascitis.
•To perform this test, first stretch plantar fascia. Then use your thumb or finger
to feel the plantar fascia. If plantar fascia is tender, then try the same maneuver
with plantar fascia relaxed.
•If pushing the stretched plantar fascia causes more tenderness than pushing
on the relaxed plantar fascia, then the plantar fascia is likely the source of the
pain and the patient have plantar fascitis.

22. CONSERVATIVE
TREATMENT

23. Not all of these treatments are appropriate for every condition, but
they may be helpful in certain situation.

25. Modified Foot wear
Can help to soothe pain
Shoe inserts

26. Stretching

27. TAPING
• Calcaneal taping or low-dye taping used for short-term
pain relief. Taping does cause improvement in
function.

28. Injection Therapy : Local
corticosteroid injections can help
to reduce inflammation and relieve
pain.
Weight reduction

29. Modalities
•Therapeutic ultrasound
•Extracorporeal shockwave therapy
(ESWT).

30. ELECTROTHERAPY

31. NIGHT SPLINTS
• It is used for patient with symptoms greater than 6
months in duration.
• The desire length of time for wearing the splint is 1
to 3months.
• This splint maintain ankle in neutral position and
toes in slight extension.

32. SUMMARY
• Plantar Fasciitis is a painful condition caused by
overuse of the plantar fascia or arch tendon of the
foot.
• The most common cause of plantar fasciitis is very
tight calf muscles
• Treatment can last from several months to 2 years
• Some people may need surgery.