Rehabilitation of plantar fasciitis

The causes of plantar fascia inflammation are mostly due to the biomechanical changes of lower limbs, such as flat feet, heel valgus, low arch, etc. The plantar fascia is over-stretched. Long-term traction can cause plantar fascia and peripheral soft tissue inflammation and pain, and serious tendon degeneration. Other factors include overweight, long-term standing work and lack of exercise.

The patient usually feels a dull pain near the medial part of the heel bottom, sometimes even a tingling sensation. Sitting up for a long time and walking for the first 5-10 minutes can aggravate the pain and then slowly subside. Because the plantar fascia will become relaxed after a night's sleep, but inflammation makes tendons inelastic, and the plantar fascia fails to adapt to the sudden tension when getting up and landing in the morning, most patients will express the most painful moment when getting up and landing on both feet in the morning. Clinical examination showed that the joint of plantar fascia and calcaneus had obvious tenderness and extended to the front of the plantar, and the extension of plantar fascia also caused pain.

Many patients with plantar fasciitis find bony spurs in the protuberance of calcaneus on X-ray examination. They think that they are the culprit of plantar pain. However, the fact is that the plantar fascia is pulled for a long time, which leads to the prominence of calcaneal protuberance with bone hyperplasia (commonly known as "raw spurs"). Anyone who is older can see spurs more or less on X-rays in different weight-bearing joints of the body, but Spurs are not the cause of plantar pain.

Initial treatment - If there is obesity, symptomatic flatfoot and systemic inflammation, treatment should be given. Otherwise, it should start with conservative treatment, including pain relief measures, changing shoes or habits, and exercise therapy.

• Rest and ice compress can initially relieve pain.

• NSAID is often used.

• Wearing slippers or walking barefoot may aggravate symptoms or may cause symptoms to recur. Therefore, the first step after getting up should be to wear supportive shoes or sandals.

• Patients working or living in buildings with concrete floors should wear shock absorber pads or crepe rubber soles. Excessive heel impact caused by jumping or walking should be avoided。

• Sports shoes, arch support shoes (especially shoes with super heel stabilizers, which surround the heel and are the stable parts of the shoes) or shoes with rigid arch pads (usually inserting a piece of metal into the sole) may be helpful.

• Family exercises include plantar and sural-plantar fascia stretching. Ultrasound therapy, ice massage and deep friction massage can be used before exercise.

• Tape support for affected plantar surfaces (known as low-Dye patching) may be beneficial to some patients, especially those with first-step pain. Four tapes can be used to support in a specific way.

The tape should not be too tight. It is recommended to use low sensitivity tape to avoid allergic reaction.

Preventive strategies such as prevention-stretching exercise and intensity control of running (such as distance, frequency and duration) have no known effect on the prevention of plantar fasciitis. Shoes and socks with maximum shock absorption may be useful.

Prognosis - Patients with plantar fasciitis usually have better outcomes; about 80% of patients have complete pain relief within one year. When weighing the benefits and risks of unproven and sometimes costly treatments, it should be remembered that the natural course of this benign disease is good.