Plantar fasciitis: rock in your shoe

Plantar fasciitis is an injury to the plantar fascia, a fibrous, somewhat inflexible ligament supporting the sole of your foot. Repetitive movements that stretch the plantar fascia can cause small tears that lead to swelling and pain.

What are the similarities between plantar fasciitis and Lenoir’s facet?

Lenoir’s facet, or heel spur, is a potential consequence of plantar fasciitis. About half of those suffering from plantar fasciitis also suffer from Lenoir’s facet. It is characterized by an abnormal, small, bony protuberance where the plantar fascia meets the heel bone.

This protuberance forms when the bone is forced to adapt to resist excessive stretching of the tendon in a manner that allows it to better support the increased tension.

In rare cases, the protuberance is big enough to cause painful pressure, and surgery is then required to extract it. But usually, pain associated with Lenoir’s facet is in reality caused by inflammation, which occurs due to plantar fasciitis. Once the fasciitis is treated, Lenoir’s facet remains, but does not cause any pain.

What are the symptoms of plantar fasciitis?

The main symptom is pain, which occurs mainly in the morning, although it can also come and go throughout the day, particularly after physical activity. The pain can be acute or moderate, or simply translate into some heel sensitivity.

What can cause plantar fasciitis?

Plantar fasciitis can occur in different contexts where the plantar fascia and the heel are placed under increased stress. The most common factors include:

• Practicing sports without muscle or tendon warm-up, or without the right equipment;
• Walking barefoot on dry beach sand;
• Wearing shoes that poorly support your heels or the arch of your feet, namely due to excessively hard heels or soles;
• Walking or standing on hard surfaces for prolonged periods.

Who is most at risk of plantar fasciitis?

Plantar fasciitis is the second most common diagnosis among Canadians suffering from foot pain. Therefore, there are numerous people considered “at risk”, but it may be more frequent to find them in one of the following categories:

• Athletes, because they call on every part of their feet structure frequently and intensely. The physical activities that tend to lead to plantar fasciitis include jogging, jumping, volleyball, ski, tennis and aerobics.
• People over the age of 45, due to loss of plantar fascia flexibility over time.
• Obese individuals and pregnant women, since the excess weight adds intense pressure to the plantar fascia.
• People with flat or hollow feet.
• People with diabetes or an inflammatory disorder, such as rheumatoid arthritis.

How is plantar fasciitis treated?

When plantar fasciitis occurs, it is important to cut down on the physical activity that caused the problem, and to obtain adequate treatment before the injury worsens. People who have suffered from plantar fasciitis in the past tend to remain prone to relapses.
If you have been experiencing some pain in your foot or heel for some time, it is best to consult a physician who will assess the seriousness of the injury and discuss the therapeutic treatments available to you.
Here are a few things you can do to relieve pain until your appointment with a physician:

Ice

From the onset of foot pain, apply ice or a cold gel compress to the area for approximately 15 minutes. This will help reduce swelling. Avoid placing the ice directly on your skin. Instead, wrap it in a damp cloth. Try to stay in a position with your feet raised higher than your body. Repeat several times a day, every day.

Medication

Analgesics and anti-inflammatory medication, such as ibuprofen, can help relieve pain temporarily. They should however not be taken over a prolonged period.
If pain persists, your physician could prescribe cortisone shots to further reduce inflammation. This treatment is purely for relief purposes and can lead to complications, which is why it is used as a last resort.

Support devices

A great part of the plantar fasciitis treatment consists in providing foot support in order to rest the plantar fascia. There is a variety of support devices that can help achieve this:

Orthopaedic soles and heel pads

Orthopaedic soles and heel pads are small cushions that are inserted in your shoes. They are temporary solutions, but provide good support, as you wait for your feet structure to strengthen.

Sports bandage

This type of bandage seeks to support the arch of your feet. It is mainly used for stretching or when doing a physical activity, while allowing your plantar fascia to rest.

Cast

Sometimes, a cast may be necessary for a month or two in order to rest your plantar fascia.

Braces and splints

The use of a day brace or splint can be considered to substitute a cast. There are also special splints that can be worn at night to support and stretch the plantar fascia.

Treatments and exercises

Some targeted exercises can help alleviate muscle tension, promote healing, and prevent relapses.

Stretching exercises
It is recommended to stretch your calves, your Achilles tendon and the arch of your feet regularly. Here are some suggestions:

• When sitting, place a tissue on the floor and try to grab it with your toes. Repeat several times.
• Still in a sitting position, place a towel under your foot and straighten your leg to create a resistance.

Massages

You can also massage your foot, from heel to toe. Rubbing your plantar fascia regularly will help soften it. It is recommended to perform this type of massage before and after a demanding physical activity.

Rehabilitation treatments

Rehabilitation treatments with a physiotherapist are also very efficient. Your physiotherapist will design a program that is suited to your condition to allow you to relieve the tension in your fascias, as well as in your legs and pelvis, which are all interrelated.

Rest

Plantar fasciitis treatment requires patience. It is slow to heal. During your convalescence, rest your feet as much as possible.
As long as you experience pain, you need to cut down on, or even stop, physical activities that call on your supporting joints. You could temporarily switch to sports that don’t require the use of your heel and arch, such as swimming, cycling or machine weight training.
To avoid getting up on the wrong foot, wear slippers from the instant you get out of bed. It is contraindicated to walk around barefoot as long as the pain hasn’t completely disappeared.

Surgery

For plantar fasciitis like Lenoir’s facet, surgery is only a last resort; that is, after at least a year of unsuccessful treatments or unsatisfying relief.
Surgery consists in partially severing the plantar fascia to reduce tension. This intervention has a 95% rate of success. However, it carries the risk of after-effects, including the weakening of the arch.

Sources
http://www.passeportsante.net/fr/Maux/Problemes/Fiche.aspx?doc=fasciite_plantaire_epine_lenoir_pm
http://pilule.telequebec.tv/occurrence.aspx?id=803
http://sante.canoe.ca/condition_info_details.asp?disease_id=305
http://www.cliniquedupiedequilibre.com/problemes-de-pieds/douleurs-aux-pieds/epine-de-lenoir