The plantar fasciitis is a foot injury caused by stretching or rupture of the plantar fascia , a fibrous membrane that runs from the heel bone to the base of the toes. This membrane is, in a way, the “floor” of the foot. About 1% of the population is affected.
This condition is manifested primarily by heel pain . It is the athletes who are most often affected, because they seek more frequently and intensively all the structures of their feet.
When such a problem occurs, it is important to reduce physical activity and to have adequate care. Otherwise, the fasciitis is likely to get worse. People who have suffered once are fragile.
Note . This condition is also known to fasciitis plantar . The term fascia is synonymous with fascia.
Causes of Plantar fasciitis and calcaneal spine
Any of the following situations may be the cause.
- The practice of sports without adequate preparation of muscles and tendons, or without adequate equipment . Running, jogging, jumping, team sports (volleyball, etc.), skiing, tennis, aerobics and training on a staircase simulator are some of the most important physical activities. more at risk;
- Obesity. This is a major risk factor for plantar fasciitis, especially because excess weight often increases tension in the muscle chain at the back of the legs. These tensions reverberate on the feet;
- The wearing of shoes that support the arch and heel poorly, resulting in a biomechanical imbalance. This is particularly the case of shoes whose soles or heels are too hard, as well as those whose soft buttresses do not sufficiently stabilize the heels;
- The hollow legs or flat feet ;
- Walking or standing up on hard surfaces .
Moreover, it is known that the normal aging of the plantar fascia makes it more susceptible to tears. Indeed, fascia loses flexibility with age.
From a physiological point of view, plantar fasciitis is a reflection of inflammation of the plantar fascia (the suffix ite means inflammation). This fascia covers and protects the tendons as well as other deep structures of the foot. It helps to maintain the arch . Inflammation appears as a result of fascial wear . If it is over or under stress, microdissure or larger lesions may appear.
The calcaneal spine, a consequence of plantar fasciitis
Since the foot is constantly solicited by standing and walking, the pain may persist if nothing is done to correct the situation.
Over time, a calcaneal spine, also known as Lenoir’s spine, may appear (see diagram). About half of people with plantar fasciitis also have a calcaneal spine.
Definition of the calcaneal spine
It is a small bony outgrowth that develops where the plantar fascia joins the heel bone (calcaneus). This excrescence is formed because the bone must be organized to better resist the tendon that “pulls” more. The outgrowth allows him to support this increased tension. It is also called calcaneal exostosis .
In very rare cases, the calcaneal spine forms a bone growth that is large enough to feel under the skin. It can then create a local pressure to the point that it must be excised. Still, most often, the pain that was previously associated with this growth is actually explained by the inflammation of the fascia. Most of the time, when it is cured, Lenoir’s spine remains, but does not cause any pain.
SYMPTOMS of Plantar fasciitis and calcaneal spine
- A heel pain , light or stronger, as applicable;
- This pain is most evident in the morning , at sunrise. The pain may disappear and return after a period of physical activity.
People at risk for Plantar fasciitis and calcaneal spine
- People who have flat feet or hollow feet;
- People aged 45 and over (especially women)
- Pregnant women, because of their increased weight;
- People with diabetes or an inflammatory disease, such as rheumatoid arthritis.
- The practice of certain sports, in particular running and jogging;
- Wearing unsuitable or worn shoes;
- The absence of a warm-up period before training;
- Hard work and prolonged standing.
The prevention of plantar fasciitis (Lenoir’s spine)
|Basic preventive measures|
|The following tips will prevent the appearance of plantar fasciitis and its recurrence , as well as the Lenoir spine that may be associated with it.
Be careful about sports practice . In addition to having proper footwear , it is important to consider the following recommendations:
Medical treatment of plantar fasciitis (Lenoir’s spine)
Treatments almost always give good results, but it can take several months to achieve a complete cure.
We must first find the cause of fasciitis. It is often advisable to limit the practice of sports that contribute to the problem, as long as the symptoms persist.
When pain is present, for example after physical activity , apply an ice pack for 5 to 15 minutes to relieve inflammation. Avoid applying the bag directly to the skin (see our video above). Set up so that the feet are higher than the body.
Treatments and exercises
Treatments of rehabilitation with a specialist (physiotherapist or athletic therapist) can help release tension in the fascia under the foot. It is possible that the therapist also treats the fascia muscles of the pelvis and legs. When they are relaxed, the tension also relaxes in the fascia of the Achilles tendon and the foot , because the fascia is connected. Some stretching exercises also help healing and prevent recurrence. The doctor and the podiatrist (or chiropodist) is other resource persons, if necessary.
Here are 2 exercises that can be done at home:
|In a sitting position: stretching of the plantar fascia
|When standing: Achilles tendon stretching
Stand in front of a wall at a distance of about 60 cm. Then put the palms of your hands against the wall. Then do the following 2 exercises one after the other and several times:
- Place a tissue on the floor and grasp it with your toes. Do this many times;
- Place a tennis ball under the arch. It is to roll it a few times towards the heel then towards the vault, by adjusting the pressure according to the pain felt.
- Nonsteroidal anti-inflammatory drugs. Aspirin or ibuprofen (Advil, Motrin, Apo-Ibuprofen, etc.) can help relieve pain temporarily . Their effect is modest, however.
Warning . Exercise should be avoided after taking an anti-inflammatory, because you risk injuring yourself by forcing too much under the analgesic effect of this type of medication;
- Injections of cortisone. If other treatments are not effective enough, cortisone injections can be used to further reduce inflammation. This is a relief treatment. Injections can be repeated, with an interval of at least 3 months between each injection. Of complications , such as thinning of the fat pad that protects the heel or the rupture of the plantar fascia, are possible. This is why injections are only used after trying other treatments.
- Plantar orthosis. This is an orthopedic insole inserted into the shoe. It is a temporary solution that gives good support to the feet, until the foot structures are strengthened. Although this type of support is commonly used, its effectiveness in relieving pain has not been clearly demonstrated. Various types of orthoses are available on the market: prefabricated (in pharmacy, at a cost of about $ 20, or better quality in specialized stores, for about $ 150) and molded orthoses, made to measure (more than 300 $). Usually, a prefabricated orthosis is enough, but it depends on the case;
- Adhesive bandage for the sport. The arch can be supported with this type of bandage, especially when it comes to stretching or continuing to exercise while allowing the plantar fascia to rest;
- Splint. There are special braces that are worn during the night and serve to support and stretch the plantar fascia. One can also wear one during the day; it then replaces the plaster. Their effectiveness is however uncertain;
- Plaster. Sometimes, a plaster is installed for 4 to 6 weeks to force the rest of the plantar fascia.
For plantar fasciitis, as for Lenoir ‘s spine , surgery is only used as a last resort. It is only considered after 1 year of treatment without satisfactory relief.
The surgery involves partially cutting the plantar fascia, which reduces the tension. This intervention is a success in 95% of cases. However, it can cause sequelae, such as sagging of the arch of the foot.
The removal of the Lenoir spine is sometimes necessary when it forms a large bone growth that creates local pressure.
|Advice and home care