Saturday, June 19, 2010

Plantar Fasciitis, Part 1

Over the past 15 months, I've received more erroneous info on PF than beneficial. It has been enormously difficult to figure out the correct remedies for my own PF because there are too many one-type-of-PF mentalities out there and too many people dish out virtual absolutes about what you should do without realizing there are different collections of situations that lead to PF and therefore various proper therapies. One of the problems is I was given lots of advice that is correct - but wrong for my specific type of PF (falling/failing arch). I found lots of medical studies online, but none (not even specialist reports from sports orthopedic surgeons) describe all the various types of PF and various therapies like I have here. Yet all of my PF report has been gleaned from various reports and learned friends. There just isn't any single report that seems to have all of this in one place.
There have been a few times in the past many months when I figured I knew it all and my report would be accurate, but then I'd hear/see/read more that blew the problem into a more complicated mess. Again, i think I have it right, but these five reports are subject to change.
I hope this helps other people who have PF to get on-track immediately.

Definitions and diagnoses
Fascia is connective tissue. Its purpose is to keep your soft tissues positioned at the proper locations. The plantar fascia continuously elongates during the contact phase of gait. It goes through rapid elongation before and immediately after mid-stance, reaching a maximum of 9% - 12% elongation between mid-stance and toe-off. During this phase the plantar fascia behaves like a spring, which may assist in conserving energy. In addition, the plantar fascia has a critical role in normal mechanical function of the foot, contributing to the "windlass mechanism”; the plantar fascia being the cable, the metatarsal head the drum, and the handle, the proximal phalanx. Plantar fascia is not a muscle, not a tendon.

Muscles are dynamic cells which can actively change length.
Tendons are elastic tissues which connect muscle to bone.
Ligaments connect bones to each other, most importantly at joints. Ligaments are meant to limit the range of motion to keep joints inside the optimal range of structural integrity.
Fascia most often connects soft tissue to soft tissue, but some fascia connects bone to bone, such as the plantar fascia. The difference between ligaments and fascia is that ligaments have no mechanical roles. Ligaments bend, flex, and stretch a minimal amount. Fascia is meant to stretch even less. The role of the plantar fascia is similar to a hoist-cable on a crane, but inverted.

There are generally two causes of PF, but one way can be divided two different ways. One is blunt-trauma; the other two are from the plantar tearing. Tearing can be caused by over-stretching (low and falling arches), or it can be caused by tightness (arches that are too high), which may or may not then lead to falling arches.

Plantar fasciitis (PF) can be the first stage of “falling of the arches”. The plantar starts to tear, usually from one of the attachments, and most commonly from the heel.

Some misdiagnoses occur when other injuries nearby are mistaken for PF.
Sometimes, rather than the plantar tearing off the heel, they develop fractures near the plantar attachment.
Enthesitis (Inflammation Where the Ligaments Attach to the Bone)
Inflammation of the enthesis, where the joint capsules, ligaments or tendons attach to the bone, is a hallmark of ankylosing spondylitis (AS). This can be felt in multiple areas of the body where your doctor can check for pain and tenderness. The sites are sometimes referred to as "hot-spots." They can lead to swelling and tenderness along the back, pelvic bones sacroiliac joints, the chest, and the heel. The heel can be significantly affected, in which case the pain and tenderness can have a serious impact on a person's mobility. The two areas of the foot that can be affected are the Achilles tendon at the back of the heel, and the plantar fascia at the base of the heel. Reiter's syndrome is part of osteoarthritis and rheumatoid arthritis. These two are not sport-injuries, but chronic conditions.

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