Metatarsal Fracture

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Metatarsals are the long bones in the forefoot. There are five in each foot, one leading up to each toe and forming the metatarso-phalangeal (MTP) joints with the phalanges (toe bones) at the base of each toe. They also form the tarsal-metatarsal (TMT) joints with the tarsal bones towards the ankle.

Types Of Metatarsal Fractures:
The metatarsal bones are some of the most commonly fractured (broken) bones in the foot. There are two main types of metatarsal fractures:
  • Acute fractures - due to an acute (sudden) injury to the foot (commonly dropping a heavy object onto the foot, a fall, or a sporting injury)
  • Stress fractures - due to overuse, or repetitive, injury to a normal metatarsal bone
                                                            Acute Metatarsal Fracture

The fifth metatarsal bone is the most common metatarsal bone that is fractured in acute (sudden) injury to the foot. However, other metatarsal bones may also be broken. The first, second and fifth metatarsals are the most commonly injured in sport. Several English footballers including David Beckham and Wayne Rooney have had metatarsal fractures in recent years.

The fifth metatarsal bone may be broken at various points along its length, depending on the mechanism of injury causing the fracture. Briefly, the fifth metatarsal bone has a base (nearest to the heel of the foot), a tuberosity (a bony prominence that protrudes from the base), a shaft (the main body of the bone), a neck and a head.

Acute metatarsal fractures can also be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed, or moved, its position

Symptoms Of Acute Metatarsal Fracture:
  • Acute pain at the point of trauma.
  • Rapid swelling.
  • Inability to weight bear.
  • There may be deformity in the foot.
  • Bruising will usually develop within 24 hours.
                               Stress Metatarsal Fracture

A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as 'overuse injuries'. A metatarsal stress fracture is a stress fracture in one of the metatarsal bones in the foot. Historically, a metatarsal stress fracture has been called a march fracture because it was seen in soldiers who were marching for long periods of time. However, metatarsal stress fractures are not only seen in military recruits. They are commonly seen in athletes (especially runners), ballet dancers and gymnasts. Metatarsal stress fractures can affect anyone: not just olympic athletes. They are seen in runners of all levels.

Causes Of Stress Fractures
  • Overuse
  • Too much training, too soon without enough rest!
  • Overpronation
  • Oversupination
  • They are common in army recruits (often called a march fracture), runners, ballet dancers and gymnasts.
Symptoms Of Stress Fractures
  • Foot metatarsal pain which comes on gradually.
  • Pain is located towards the mid/front of the foot.
  • Pain is aggravated by weight bearing activities such as walking, running or dancing.
  • Pain to touch the bone at the point it is broken.
  • Swelling is often present.
  • An X-ray will often not show the fracture until two or three weeks after it has started to heal.
Investigation:
X-rays will be taken of the foot to confirm a fracture.


                             Treatment Protocol For Metatarsal Fracture
  • Rest from weight bearing activities as much as possible.
  • For those whose job requires them to weight bear, a walking boot may be used.
  • The rest period should normally be around 4 weeks to allow sufficient healing.
  • Recommence activities only once all pain on touch and walking have cleared.
  • Start with a very slow return to activity and a gradual build of duration and intensity.
  • If the stress fracture may have been caused by abnormal foot mechanics such as overpronation or oversupination then orthotics may be required to correct this.
Metatarsal Fracture Rehabilitation

Rehabilitation of a metatarsal fracture may begin at different stages, depending on whether it is an acute fracture or a stress fracture and also the extent and location of the injury. Acute metatarsal fractures which require complete immobilisation (in a cast) will not begin rehabilitation until after the cast is removed. Stress fractures which requires a reduction in weight bearing for 2-4 weeks, can begin rehabilitation once full weight bearing and the exercises involved are pain free.

Mobility exercises

Ankle range of motion
Start by moving the ankle through its full range of motion, you can do this using ankle circles or by writing the alphabet with your toes! Try to practice doing this on a regular basis to help reduce stiffness and also to ease swelling and increase blood flow to the injury.

Toe range of motion
Point your toes up and then down as far as possible. Hold each position for a few seconds and then reverse. Try to spread your toes apart as far as possible and then to scrunch them up as well. Hold for a few seconds, before reversing the movement.

Calf stretches
It is common for the calf muscles to tighten up after any injury, especially if a period of immobilisation or reduced weight bearing is required. Stretch both calf muscles regularly every day:

To stretch the Gastrocnemius, stand with a wide stance, with the leg to be stretched at the back. Keep the heel on the floor and the knee straight as you lean forwards. When you feel a stretch in the calf, hold this position for 20-30 seconds. If the stretch fades in this time, then lean a little further forwards until you can feel it again,

To stretch the Soleus muscle, Stand with a narrower stance, still with the leg to be stretched at the back and the heel down. This time, bend both knees as if trying to squat down, you should feel a stretch lower down the calf, around the achilles tendon. Again hold for 20-30 seconds and maintain that stretching feeling.

Repeat both stretches 2-3 times and several times a day.
 
 

Metatarsalgia

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Metatarsalgia is a condition marked by pain and inflammation in the ball of your foot.

Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe).


Causes For Meratarsalgia:
Metatarsalgia can be caused by a number of different conditions. Common causes include:
  • Overuse - For example, in runners and athletes, which can cause some mild inflammation in the metatarsal heads and nearby joints. Other sports such as tennis or sports that involve jumping may also put extra stress on the metatarsal heads and lead to inflammation and pain.
  • Wearing high-heeled shoes - This can put extra stress on the metatarsal heads. Footwear that is poorly fitted or too tight may also be a cause.
  • Being overweight- This can put extra stress on the feet in general.
  • Having a stiff ankle or Achilles tendon (the tendon at the heel) - This can affect the way that pressure is distributed across the foot and may lead to extra stress on the metatarsal heads.
  • Morton's neuroma - This is sometimes called Morton's metatarsalgia. It is a condition that affects one of the nerves that run between the metatarsal bones in the foot (the plantar digital nerves). Symptoms include pain, burning, numbness and tingling between two of the toes of the foot. See separate leaflet, 'Morton's Neuroma', for more detail.
  • Pes cavus- This is also known as claw foot. In pes cavus, your foot has a very high arch which does not flatten when you put weight on your foot. It happens because of an imbalance in the muscles of the foot. It can run in families. Sometimes pes cavus can happen out of the blue but most people with pes cavus also have a neurological problem such as cerebral palsy, spina bifida, muscular dystrophy or polio. Pes cavus can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.
  • Hammer toe or claw toe deformity - With a claw toe you have an abnormal position of all three of the joints in the toe. The joint with the metatarsal bone is bent upwards, the middle joint in the toe is bent downwards and the end joint in the toe may also be bent downwards. The toe resembles a claw. With a hammer toe, your toe is permanently bent at its middle joint so that it looks like a hammer. There are a number of conditions that can cause these toe deformities. These can include poorly fitted shoes, injury to the toes, bunions and rheumatoid arthritis. Hammer and claw toe can also occur in someone with pes cavus. They can also run in families. These toe deformities can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.
  • Bunion (hallux valgus)- A bunion is a deformity of the base joint of the big toe, causing the big toe to be angled towards the second toe. This causes a bump on the side of the foot at the base of the big toe. There is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful. Because of the bunion, extra stress is put on the ball of the foot and this can lead to metatarsalgia. See separate leaflet called 'Bunions' for more detail.
  • Previous surgery to the foot- For example, previous surgery for bunions.
  • Stress fracture of a metatarsal- A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as overuse injuries. A metatarsal stress fracture is a stress fracture in one of the metatarsal bones in the foot. See separate leaflet called 'Metatarsal Fractures' for more detail, including metatarsal stress fractures.
  • Arthritis or gout -  This can cause inflammation of the joints in the ball of the foot or of the big toe and can be a cause of metatarsalgia. See separate leaflet called 'Gout' and those on arthritis for more detail.
  • Diabetes - This can cause damage to the nerves in the feet and can be a cause of metatarsalgia. Please refer to the separate leaflets on diabetes for more details.
Symptoms Of Metatarsalgia:
  • Sharp, aching or burning pain in the ball of your foot — the part of the sole just behind your toes
  • Pain in the area around your second, third or fourth toes — or, only near your big toe
  • Pain that gets worse when you stand, walk or run and improves when you rest
  • Sharp or shooting pain in your toes
  • Numbness or tingling in your toes
  • Pain that worsens when you flex your feet
  • A feeling in your feet as if you're walking with a pebble in your shoe
  • Increased pain when you're walking barefoot, especially on a hard surface.
Investigation:
- X-rays, MRI's or Ultrasound scans can be used to look inside the foot to view any damage.
- Blood tests may be taken to diagnose any underlying medical causes such as diabetes or gout.
- A podiatrist may assess your foot position and gait (walking pattern).

                        Treatment For Metatarsalgia
  • NSAID's such as ibuprofen (non steroidal anti inflammatory drugs) may reduce pain and inflammation. Always speak to your Doctor first.
  • Use padding to protect the foot and re-distribute weight on the foot.
  • Use gel type shock absorbing and cushioning insoles.
  • Wear flat, spacious shoes.
  • Stretch your calf muscles regularly throughout the day.
 
 

Athletes Foot / Tinea Pedis

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Athletes foot (also known as Tinea Pedis) is a skin infection which is commonly thought to occur amongst athletes and those who wear trainers and other non-breathable footwear.

It is caused by a fungus, called Trichophyton which thrives in warm, moist environments. Athletes foot most commonly affects the toes and in between them, however it can also affect the soles of the feet.

Athletes foot is contagious, however the foot has to provide the right conditions for the fungus to thrive. It may be passed through direct contact and also by using the same towels, socks or from changing room floors.

Athletes foot can appear in anyone, although it is more common in teenagers and men. Some people also seem to be more prone to developing the condition, although it is not known why. The prevalence in 'athletes' may be due to wearing enclosed footwear which becomes very hot and sweaty during exercise, but is probably also linked to using communal changing areas in pools and health clubs.

Causes Of Athletes Foot:

Athlete's foot occurs when a certain fungus grows on your skin in your feet. In addition to the toes, it may also occur on the heels, palms, and between the fingers.

Athlete's foot is the most common type of tinea fungal infections. The fungus thrives in warm, moist areas. Your risk for getting athlete's foot increases if you:
  1. Wear closed shoes, especially if they are plastic-lined
  2. Keep your feet wet for prolonged periods of time
  3. Sweat a lot.
  4. Develop a minor skin or nail injury

Athlete's foot is contagious, and can be passed through direct contact, or contact with items such as shoes, stockings, and shower or pool surfaces.

Symptoms of Athletes Foot:
  • Varying degrees of itching or burning.
  • Often peeling or flaking skin is present.
  • Mild cases may appear as just dry skin.
  • More severe cases may present with blisters or thick patches of dry red skin.
  • In extreme cases the skin may crack and result in bleeding

                     Treatment For Atheletes Foot:

Athletes foot treatment should be two fold.
Firstly Stage -  the area should be made less suitable for the fungus to grow. This means keeping the area clean and dry. Try to only wear breathable shoes (leather and natural materials are better than synthetics). Absorbent cotton socks are also recommended.

Second stage - involves directly treating the infection. This can be done with anti-fungal creams, powders or washes. Many of these products are available from your local pharmacist. They should be used on a daily basis until you have been symptom free for at least a week.

More resistant or severe cases may require a course of oral anti-fungal medication. These are only available on prescription from your Doctor.

Preventing Athletes Foot:

Athletes foot does have a tendency to return and so it is important to continue to look after your feet by following these simple steps:
  • Wear leather shoes, or even open shoes when possible.
  • Wash your feet regularly and make sure you dry them thoroughly.
  • Use powders (such as talcum powder, or even anti-fungus powder) to make sure your feet are completely dry after washing.
  • Wear flip-flops or sandals when using communal changing areas.
  • Wear cotton socks and change them regularly.



 

Turf Toe

09/06/2011

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Turf Toe

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A sprain to the first metatarsophalangeal (MTP) joint , otherwise known as a 'Turf Toe' or 'death toe' , is a common injury in athletes in which the plantar capsule and the ligament of first metatarsophalangeal joint is damaged.

The first MTP joint ROM is variable. The neutral position is described by 0 (or 180) degrees angulation between a line through the first metatarsal and the line through the hallux. Dorsiflexion , the ROM above the neutral position, varies between 60-100 degree. Plantar flexion, the ROM below the neutral position, varies between 10-40 degrees. The ROM is noncrepitant and pain free in the uninjured joint.

Anatomy Related To Turf Toe:

The power to move the MTP joint is provided by both intrinsic (flexor hallucis brevis, extensor hallucis brevis, abductor hallucis, adductor hallucis) and extrinsic (Flexor hallucis longus, extensor hallucis longus) muscle groups. Two sesamoid bones (medial, or tibial, sesamoid and lateral, or fibular, sesamoid) provide mechanical advantage to the intrinsic plantar flexors by increasing the distance between the empirical centre of joint rotation and the respective tendons. The sesamoid complex articulates with facets on the plantar aspect of the first metatarsal head and is stabilized by a plantar capsule (plantar plate) as well as a ridge (or crista) on the metatarsal head that separates the two sesamoids.


Symptoms Of Turf Toe Include:
  • Swelling and pain at the joint of the big toe and metatarsal bone in the foot.
  • Pain and tenderness on bending the toe or pulling (stretching) it upwards.
Causes For Turf Toe:
Turf toe can be caused by either one traumatic injury or from repetitive injuries that continue to aggravate the original injury. Most turf toe injuries are caused by a hyperextension injury when the toe hits an unyielding surface (i.e., opponent, artificial turf, or hard ground) forcing the toe beyond its normal range of motion.


Classification of metatarsophalangeal joint sprain (Turf Toe)
    Grade - 1 
  • Objective findings-No ecchymosis. Minimal or no swelling. Local plantar or medial tenderness.
  • Pathologic condition-Stretching of capsulo-ligamentous complex.
  • Treatment-Ice/elevation. NSAIDs. Rigid insole. Continued participation in sports.
  • Return to sports-Immediately.
    Grade - II
  • Objective findings-Ecchymosis. Minimal swelling. Diffuse tenderness. Pain, restriction of motion.
  • Pathologic condition-Partial tear of capsulo-ligamentous complex.
  • Treatment-Same as Grade I. Restriction of athletic activity for 7-145 days.
  • Return to sports-1-14 days.
    Grade - III
  • Objective findings-Consideable ecchymosis and swelling. Severe tenderness on palpation. Marked restriction of motion.
  • Pathologic condition-Tear of capsulo-ligamentous complex. Compression injury of articular surface.
  • Treatment-Same as Grade II. Crutches and limited weight-bearing. If MTP dislocated, reduction and immobilization initially with case. Restriction of athletic activity.
  • Return to sports-3-6 weeks.
Assessment of Turf Toe
Bending the toe backwards stresses the ligaments on the underside of the 1st MTP joint. When these ligaements are damaged this may result in pain. Other Inverstigation Is X-Ray. Plain X-rays are generally unremarkable, although occasionally small periarticular flecks of bone are noted, most likely indicating avulsion of MTP capsule or ligamentous complex.


Physiotherapy Treatment For Turf Toe

  • Ice the injury immediately.
  • Apply a compression bandage.
  • Rest - which might include crutches to take the weight off the toe.
  • Use a Brace to protect the toe - or at the very least wear a shoe that has a firm sole that will not allow bending.
  • Apply Ultrasound or other electrotherapy treatment.
  • After 2 to 4 days may be able to weight bear again.
  • Tape the toe to prevent movement.
  • Strengthening Exercises should be start.

Rehabilitation Protocol For Turf Toe:
    Stage 1 : Acute Stage- Day 0 to 5
  • Rest, ice bath, contrast bath, whirlpool, and ultrasound for pain, inflammation, and joint stiffness.
  • Joint mobilization, followed by gentle, passive and active ROM.
  • Isometrics around the MTP joint as pain allows.
  • Cross-training activities, such as water activities and cycling, for aerobic fitness.
  • Protective taping and shoe modifications for continued weight bearing activities.
    Stage 2 : Subacute Stage- Weeks 1-6
  • Modalities to decrease inflammation and joint stiffness.
  • Emphasis on flexibility and ROM, with both active and passive methods and joint mobilization.
  • Progressive strengthening by toe pick-up activities, towel scrunches and manual resistive hallux MTP dorsi flexion and plantar flexion. Seated ankle and toe dorsiflexion and progression to standing. Seated isolated toe dorsiflexion and progression to standing. Seated supination-pronation with progression to standing.
  • Balance activities, with progression of difficulty to include BAPS.
  • Cross-training activities (slide board, water running, cycling) to maintain aerobic fitness.
    Stage 3 : Chronic Stage- Week 7
  • Continued use of protective inserts and taping.
  • Continued ROM and strength exercises.
  • Running, to progress within limits of a pain-free schedule.
  • Balance activities.
  • Plyometrics and cutting program, with progression of dificulty.
 
 

Broken Toe

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A broken toe is a common injury that most often occurs when you drop something on your foot or stub your toe.

In most cases, a broken toe can be immobilized by taping it to a neighboring toe. But if the fracture is severe — particularly if it involves your big toe — you may need a cast or even surgery to ensure that your broken toe heals properly.

Most broken toes heal well, usually within four to six weeks. Less commonly, depending on the precise location and severity of the injury, a broken toe may become infected or be more vulnerable to osteoarthritis in the future.

Common Causes Of Broken Toe:

Fractures to the phalanges usually occur as a result of a direct trauma, such as something being dropped on the foot, or even stumping your toe! The Hallux (or big toe) can suffer a stress fracture, which is common in adolescent athletes.

The most common toe fractures include a broken big toe and broken little toe (pinky toe). This is because these two toes are more exposed, the others are protected more by the other toes.

Symptoms Of Broken Toe:
Signs and symptoms of a broken toe include:
  • Pain
  • Swelling
  • Discoloration
                          Treatment For Broken Toe
Medication
The pain associated with simple toe fractures typically can be relieved with over-the-counter medications such as ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others). Stronger painkillers can be prescribed if the pain from your fracture is more severe.

Reduction
If the broken fragments of your bone don't fit snugly together, your doctor may need to manipulate the pieces back into their proper positions — a process called reduction. In most cases, this can be accomplished without cutting open your skin. Ice or injected anesthesia is used to numb your toe.

Immobilization
To heal, a broken bone must be immobilized so that its ends can knit back together. Examples include:

Taping - If you have a simple fracture in any of your smaller toes, your doctor may simply tape the injured toe to its neighboring toe. The uninjured toe acts like a splint. Always put some gauze or felt in between toes before taping them together, to prevent skin irritation.

Wearing a stiff-bottomed shoe = Your doctor might prescribe a post-surgical shoe that has a stiff bottom and a soft top that closes with Velcro. This can prevent your toe from flexing and provide more room to accommodate the swelling. 

Casting - If the fragments of your broken toe won't stay snugly together, you may need a walking cast.
Surgery
In some cases, a surgeon may need to use pins, plates or screws to maintain proper position of your bones during healing.

Broken Toe Rehabilitation
  • Toe passive range of motion: Use your hand to gently bend the injured toe joint. Then gently try to straighten out the toe with your hand. Repeat slowly, holding for 5 seconds at the end of each motion. Do this 10 times. Do these exercises 3 times per day.
  • Towel pickup: With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel.
  • Standing toe raise: Stand with your feet flat on the floor, rock back onto your heels and lift your toes off the floor. Hold this for 5 seconds. Do 3 sets of 10.
  • Heel raise: Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10.
  • Towel stretch: Sit on a hard surface with one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times.

 
 

Heel Pain / Bruised Heel

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A bruised heel can be caused by either a sudden impact (such as landing heavily) or repetitive pounding. The heel bone (calcaneus) is protected by a pad of fat. Repeated pounding of the heel can cause the fat pad to be pushed up the side of the heel leaving less of a protective layer causing heel pain. This injury is also sometimes known as Policeman's heel. It is common in sports requiring a lot of impact onto the heel and in particular soldiers marching up and down on the parade square.


Causes Of Heel Pain
Heel pain is a common complaint, especially amongst those who spend a lot of their time on their feet for work, or who are involved in repetitive impact sports. The cause of this pain can be varied and should be thoroughly investigated to ensure the right course of treatment is undertaken.

Common causes include
  1. Tight calf muscles.
  2. Faulty foot biomechanics – such as overpronation or oversupination.
  3. Sudden increases or changes to training.
  4. Unsupportive footwear.Wearing high heels frequently.

                             Treatment For Heel PIan / Bruised Heel
Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.

Pain Beneath the Heel
If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot:
  • Stone bruise - When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discolored. The pain goes away gradually with rest.
  • Plantar fasciitis (subcalcaneal pain) - Doing too much running or jumping can inflame the tissue band (fascia) connecting the heel bone to the base of the toes. The pain is centered under your heel and may be mild at first but flares up when you take your first steps after resting overnight. You may need to do special exercises, take medication to reduce swelling and wear a heel pad in your shoe.
  • Heel spur - When plantar fasciitis continues for a long time, a heel spur (calcium deposit) may form where the fascia tissue band connects to your heel bone. Your doctor may take an X-ray to see the bony protrusion, which can vary in size. Treatment is usually the same as for plantar fasciitis: rest until the pain subsides, do special stretching exercises and wear heel pad shoe inserts.
Pain Behind the Heel
If you have pain behind your heel, you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Pain behind the heel may build slowly over time, causing the skin to thicken, get red and swell. You might develop a bump on the back of your heel that feels tender and warm to the touch. The pain flares up when you first start an activity after resting. It often hurts too much to wear normal shoes. You may need an X-ray to see if you also have a bone spur.

Treatment includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication and wearing open back shoes.
  • Your doctor may want you to use a 3/8" or 1/2" heel insert.
  • Stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert.
  • Use nonsteroidal anti-inflammatory medications for pain and swelling.
  • Consider placing ice on the back of the heel to reduce inflammation.
 
 
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plantar fasciitis is an inflammation (irritation and swelling with presence of extra immune cells) of the thick tissue (plantar fascia) on the bottom of the foot that causes heel pain and disability.There is excessive wear to the plantar fascia or plantar aponeurosis that supports the arches of the foot or by biomechanical faults that cause abnormal pronation.The pain is usually of gradual onset and felt classically on the underside of the heel.Initially, it is worse in the morning and decreases with activity.Jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, a sudden increase in weight and over activity are also associated with the condition.

Plantar fasciitis can also be known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.

Plantar fasciitis is traditionally thought to be an inflammatory condition. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain and dysfunction is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone).

Signs And Symptoms;
  • Heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.
  • Pain when pressing on the inside of the heel and sometimes along the arch (see assessment page).
  • Pain is usually worse first thing in the morning as the fascia tightens up overnight. After a few minutes it eases as the foot gets warmed up
  • As the condition becomes more severe the pain can get worse throughout the day if activity continues.
  • Stretching the plantar fascia may be painful.
  • Sometimes there may also be pain along the outside border of the heel. This may occur due to the offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.
Causes Of Plantar Fascitis:
  1. Inflammation of plantar fascia is common in sports which involves jumping and hill running.
  2. Overuse may cause micro tears and inflammation.
  3. Normally, during midstance, the foot is flattened, stretching the plantar fascia and enabling it to store elastic energy to be released at toe off.
  4. Mal alignment faults may increase stress on the fascia, excessive rearfoot pronation will lower the arch and overstretch the fascia.
  5. Weak peroneii, often the result of incomplete rehabilitation of ankle sprain will reduce the support on the arch thus stressing the plantar fascia.
  6. Congenital problems such as pes cavus and pes planus will also leave an athlete more susceptible to plantar fasciitis. 
  7. Plantar fascitiis is exacerbated if the achilles tendon is tight or if high heels are worn.
  8. Inadequate rearfoot control may fail to eliminate hyper pronation and a poorly fitting heel counter will allow the calcaneal fat pad to spread at heel strike transmitting extra impact force to the calcaneus and plantar fascia.
  9. On a hard surface the shock absorbing qualities of the shoe are important and the patient's foot wear should be examined.
  10. Obesity is also related to plantar fasciitis.

Assessment of Plantar Fasciitis:
The video below explains how Plantar Fasciitis might be assessed and diagnosed. Assessment of any injury should include questions concerning the patients general health, previous injuries and current injury.

Other investigations can include diagnostic ultrasound, with swelling and thickening of the fascia usually apparent in positive cases, as well as X-rays, which can be used to rule out a heel spur.

               Physiotherapy Treatment For Plantar Fascitis:

Aims Of Treatment:
  1. Decrease initial pain and inflammation.
  2. Identify biomechanical disfunction.
  3. Improve flexibility.
  4. Strengthen the plantar fascia.
  5. Return to full fitness.
  6. Injury prevention

  • Rest from activities that cause pain. Stay off your feet as much as you can. Use crutches if necessary.
  • Apply Cold Therapy - Ice massage for 10 minutes to the site of pain - every hour for the first day progressing to 3-5 times a day.
  • NSAID's (Non steroidal anti-inflammatory drugs) e.g. ibuprofen may help in the early stages.
  • Gentle Stretching - should be started as soon as pain will allow - the first day of treatment if possible. Stretching the plantar fascia is essential but in addition all the muscles of the lower leg should be stretched - including the calf muscles and the tibialis anterior at the front of the leg. Continue stretching daily throughout the rehabilitation phase and long after the injury has healed.
Simple Stretching Exercises Pictures: (Click on picture to read the description)
  • Sports massage - Should be applied as soon as pain will allow - gently at first and gradually becoming deeper Massage can be performed every other day.
  • Strengthening Exercises for Plantar Fasciitis
  • Night SplintsA 5 degree dorsiflexion night splint has been reported to be beneficial.The splint holds the plantar fascia in a continuously tensed state.The theory behind the use of night splint is to minimize the change of tension on the fascia that occurs with each day's new activities.
  • Cortisone Injection - Injection of cortisone into the area close to the planar fascia often improves pain,but may weaken the plantar fascia and lead to rupture.One or possibly two steroid injections should be given in a 3-6 months period and only after failure of acute treatment measures.
  • Modalities Used in Treatment For Plantar Fasciitis
    1. Ultrasound therapy
    2. Deep friction massage
    3. Contrast bath 
    4. TENS
    5. Iontophoresis