With plantar heel pain syndrome, we know that about 10% of the population suffer from this condition. And we know that 70% of plantar heel pain is caused by this problem with the plantar fascia. So our rubber band here is very close to the location of the plantar fascia. When we stand down the plantar fascia stretches, when we take our foot off the ground, the plantar fascia pulls the foot together. So it’s a very important structure within the foot, and it makes up about 25% of the overall rigidity of the foot, which has 26 different bones that make it up.
What happens with the condition of plantar fasciitis? Well, it used to be thought of as an inflammatory condition, hence the “itis”. But now what we know more of is that it is actually a degenerative condition, which affects the collagen and has mechanical and overload type issues.
So there are a number of things that can produce the problems with plantar fascia. They can be direct compression on the fascia; it can be tension, or pulling of the fascia; and it can be frictional related rubbing under the heel of the fascia. All of these things need to be addressed in different ways. And it’s about really trying to identify what the drivers are for each specific person and their problem with plantar fasciitis.
Although there are risk factors for plantar fasciitis, such as: morbid obesity; occupational conditions where you’re standing for prolonged periods of time; lack of ankle joint dorsiflexion; and sudden increase in activities.
A lot of those conditions do have an impact on the presentation of plantar fasciitis, but it’s not an exhaustive list. And one of the things that we know about treating people and people in general is that everyone is different. So what we have to do to get an effective treatment plan is identify what the drivers of the specific pain and plantar fascia problem are for you. This will involve a detailed history of things that you have done, and often things that may have predisposed you to this condition.
What we are starting to know around this with looking at ultrasounds of the plantar fascia are that the changes can occur well before it starts to become symptomatic or painful. And often it will be a change or a transition from the type of activity or your weight or an impact that will set the condition off.
Once we have established what the primary drivers are, the treatment involves addressing those drivers and allowing you to become more active and more comfortable.