Planter fascitis

 Planter fascitis (Pain Underside of HEEL): Planter fascitis causes pain adjacent to its attachment underside the heel bone (red arrow). Usually only one foot is affected. While patient is non weight bearing he does not have any pain or have some burning sensation in the sole; but when he starts walking, the first step of weight bearing on the affected foot he gets agonizing heel pain. In severe cases pain recurs on every step of weight-bearing and may have persistent burning sensation of the sole even while resting  On examination tenderness can be elicited just anterior to the medial tuberosity of the calcaneus. Planter fascitis affects adults of any age and sex. It affects usually persons involved in sedentary and or laborious jobs like teachers, housewives, construction workers, guards etc. where their work require to them to remain prolonged standing without much movement.. All sport persons usually do not get this problem. Diagnosis is usually self evident. Rarely Radiological and/or sonographic tests may be required to rule out other medical conditions. A lateral X-ray of the affected foot at times may show unrelated minor calcaneal spur.

Anatomy of the Planter Fascia (aponeurosis-fig.): planter aponeurosis like palmer aponeurosis consists of thick bands of fibrous tissues extending longitudinally deeper and adherent to the thick skin of the mid sole (yellow line in figure). It's thickened and compact posterior end is attached to the  medial tuberosity on the bottom side of the heel-bone (calcaneus) and fans out anteriorly to divide into five bands one for each toe and gets attached to deep inter-metatarsal ligaments and divide into two slips to insert to both sides of the planter ligament of the adjacent MP joint..

Functions of planter aponeurosis: 

1. It covers and protects soft tissue (neurovascular, muscular and ligaments) lying on bottom side of the tarsal bones.

2. It helps in maintaining the medial arch of the foot between its anterior and posterior bony attachments.

3. Planter Fascia remains relaxed during the swing phase and the heel strike phase; but remains stretched like bow-string to maintain medial longitudinal arch during stance phase and during push (toe) off phase to work like a windlass for the toes to get firm grip of the ground.

Cause of pain: During walking the  relaxed planter fascia in swing phase and heel strike phase receives satisfactory blood supply; but during stance phase and push off phase when the fascia remains stretched its blood supply is gets blocked. These processes get repeated with every step of walking. Similarly, as there is no heel strike and no stance phase; the swing phase and push off phase alternates processes gets repeated while running. But when a person remains standing for long duration almost continuous, the planter fascia does not get adequate blood supply and the part of fascia with thick condensed collagen fibers close to its attachment to calcaneus which also bears major part of the body weight gets affected most. The anoxic fascia develops hyperemia with local edema when the person rests for some time. This appears to be the cause of pain under close to the heel when the person get up and starts weight bearing again.

Treatment of PLANTER FASCITIS:  treatment of planter fascitis is simple. Patient  has to avoid continuous weight bearing on the affected foot. Within 3-4 days pain will subside.  For initial 3-4 days he /she can take some analgesic and apply  liniment for pain relief. Heel pain may recur in case he/she restarts continuous standing  for long duration. There is no need for any appliance or any local injection as routinely prescribed.

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