The plantar fascia is a sturdy structure but the degree of stress that it takes makes it susceptible to injury. A force equal to almost three times body weight passes through the foot with each step. On running, this typically happens about 90 times a minute. Plantar fasciitis is thought to be a traction and overuse injury. Damage to the plantar fascia is usually in the form of micro-tears. It is a degenerative rather than an inflammatory process. Damage tends to occur near the heel, where stress on the fibres is greatest, and where the fascia is the thinnest. The fascia broadens as it extends toward the toes.
Plantar fasciitis is often associated with calcaneal spurs. These are depositions of calcium where the fascia suffers most damage. Spurs are most commonly on the medial side at the origin of the fascia from the calcaneum. Spurs are the result of the process of plantar fasciitis and not the cause of the pain. It can present bilaterally.
Also known as pes planus, this is when the arch of the foot collapses completely dropping the whole sole of the foot down to the ground. Flat feet are a common cause of foot arch pain. Babies are born with flat feet and as they grow, the foot arches should gradually form, but in approximately 30% of the population, they never do. They can also develop later in life, due to illness, pregnancy, injury, excessive stress on the feet or as part of the aging process. Many people who have flat feet don?t complain of any accompanying symptoms, but some develop foot arch pain, or problems further up the leg such as knee pain or back pain. They may find their feet tire quickly when they are standing or walking, and that it is difficult to rise up onto their tiptoes. Someone who is experiencing pain on the bottom of the foot or elsewhere due to their flat feet can benefit from exercises and orthotics (specially designed insoles to correct the foot position) as well as walking barefoot rather than in shoes. A quick test to see if you have flat feet is to put your foot in a tray of water and then place it on a smooth level surface e.g. thick paper. Have a look at your footprint, the more of the sole of the foot that you can see, the flatter your foot.
The foot of a newborn with congenital vertical talus typically has a convex rocker-bottom shape. This is sometimes combined with an actual fold in the middle of the foot. The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be. If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body.
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.
Non Surgical Treatment
The treatment of a rigid flatfoot depends on its cause. Congenital vertical talus. Your doctor may suggest a trial of serial casting. The foot is placed in a cast and the cast is changed frequently to reposition the foot gradually. However, this generally has a low success rate. Most people ultimately need surgery to correct the problem. Tarsal coalition. Treatment depends on your age, extent of bone fusion and severity of symptoms. For milder cases, your doctor may recommend nonsurgical treatment with shoe inserts, wrapping of the foot with supportive straps or temporarily immobilizing the foot in a cast. For more severe cases, surgery is necessary to relieve pain and improve the flexibility of the foot. Lateral subtalar dislocation. The goal is to move the dislocated bone back into place as soon as possible. If there is no open wound, the doctor may push the bone back into proper alignment without making an incision. Anesthesia is usually given before this treatment. Once this is accomplished, a short leg cast must be worn for about four weeks to help stabilize the joint permanently. About 15% to 20% of people with lateral subtalar dislocation must be treated with surgery to reposition the dislocated bone.
Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience.
The best method for preventing plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds. To stretch the calf muscles, place hands on a wall and drop affected leg back into a lunge step while keeping the heel of the back leg down. Keep the back knee straight for one stretch and then bend the knee slightly to stretch a deeper muscle in the calf. Hold stretch for 15 seconds and repeat three times.