ORTHOTICS PROSTHETICS RESEARCH

Definition:
Inflammation of the origin of the plantar fascia. Over-stretching of the fascia leads to excess traction and inflammation. The development of scar tissue makes the fascia less flexible and causes further traction from other parts of the foot.

Symptoms:
The patient presents with a dull to sharp pain occurring about the plantar calcaneal area when arising from rest and continuing during the initial periods of weight bearing. This normally subsides within a few minutes, but may re-occur once this sequence is re-established. The pain is often described by patients as a �stone bruise�. The pain is more severe in the morning when getting out of bed as the plantar fascia is more inflexible at those times. Surveys in the USA show that overweight patients and/or those leading a sedentary lifestyle have a much higher incidence of heel pain.

Biomechanics:
Excess subtalar joint pronation lowers the arch structure, elongates the foot and places a traction force on the plantar fascia. Over time, these tractional forces result in inflammation of the fascia and surrounding tissues, causing pain in the arch and heel. Often, the chronic traction of the plantar fascia from the calcaneal tuberosity may lead to the development of a bony growth on the calcaneal tuberosity- referred to as a �heel spur� - causing a sharp pain right in the center of the heel. Often, tight calf muscles will add to plantar fascial pain. Because of tightness in the calf, the foot cannot dorsiflex at the level of the ankle during the propulsive phase of gait. Combined with excess pronation, this results in the foot dorsiflexing at the midtarsal joint. In turn, this places extra strain on the plantar fascia.

Treatment:
Biomechanical Plantar Fasciitis is best treated mechanically by neutralising abnormal foot mechanics. Orthotics are designed to control excess subtalar joint pronation. Therefore, the device will assist the arch in rising and plantar fascial tension will be released. ORTHAHEEL features a �shock dot� which simultaneously reduces ground reaction forces under the heel and allows accommodation for any inflammatory or bony process. In some cases surgery to detach the plantar fascia from the heel bone is performed or removal of the bone spur. Surgery is very seldom required and should be avoided whenever possible. It is my experience that 95% of times patients respond well to a simple pre-molded or custom orthotic and surgery is only required in very few (extreme) cases.

Additional treatment: Ice therapy (20 minutes, several times per day), Anti-inflammatory drugs, Electrotherapeutic modalities.

Recommended Exercises:
� Plantar Fascia Stretch
� Toes raises
� Calf muscles stretch