pathology: plantar fasciitis

yogabook / pathologie / plantar fasciitis

plantar fasciitis / plantar fasciopathy

Definition of

Partly inflammatory (21%), partly fibromatous (25%), traumatic or rather degenerative painful disease of the plantar fascia, usually radiating forward from the calcaneus; peak age 40-60 years. Plantar fasciitis usually occurs as overuse syndrome and is quite common. The symptoms may be due to microtraumas caused by stress. With every step, the plantar fascia is exposed to the tensile stress of the longitudinal arch of the foot, which is loaded from the cranial side, as it acts as a tension belt for the longitudinal arch of the foot. One in ten people is affected once in their lifetime, women more frequently. 70% of cases are unilateral. In 50% of cases, a heel spur is present at the same time (usually on the quadratus plantae, but also on the abductor hallucis or, more rarely, on the abductor digiti minimi). However, the heel spur is not considered the cause of plantar fasciitis, but also occurs due to increased tensile stress. 80% have an additional shortening of the Achilles tendon / triceps surae. More than 80% show hyperpronation. Dorsiflexion is almost always reduced! 70% of those affected are obese. In athletes, there is no correlation between incidence and BMI/weight. It is not uncommon for the posterior tibialis to be insufficient, which leads to hyperpronation, increased traction on the tibial nerve and thus to tarsal tunnel syndrome. If all three occur simultaneously:

  1. Plantarfasziitis
  2. tibialis posterior-Dysfunktion
  3. Tarsal tunnel syndrome

is referred to as Heel-Pain-Triad. Additional strains or tears of the plantar fascia are possible, which usually makes any strain very painful.

Cause

  1. Possible weakness of important muscles involved in walking kinetics: gluteus medius, gluteus minimus, tensor fasciae latae
  2. Possible lack of extensibility of the triceps surae and thus reduced dorsiflexion

Predisposing

– Behavior

  1. prolonged standing or walking
  2. longer requirements with poor training level, also e.g. switching to flip-flops, sandals, barefoot walking
  3. Cross-country skiing
  4. Risk sports: basketball, tennis, soccer, dancing

– Musculoskeletal system

  1. Hyperpronation and foot misalignments that lead to
  2. Flat foot
  3. Hollow foot
  4. Leg length differences
  5. Hypertonus of the triceps surae or Achilles tendon

– Diseases

  1. RA and other arthritides
  2. Repeated cortisone infiltrations

– Other factors

  1. higher BMI
  2. Age

Diagnosis

Tests and signs: manual pressure pain provocation, Windlass test for plantar fasciitis

Symptoms

  1. morning start-up pain (decreasing pain on exertion), pain after prolonged rest
  2. Increase in pain under stress
  3. Pressure soreness
  4. gradual onset
  5. later possibly also pain at rest
  6. Sprinting and jumping aggravate
  7. palpatory sharp tenderness at the leading edge of the heel
  8. Sono: attachment of the plantar fascia to the calcaneus is at least 4 mm thick or 0.6 mm thicker in lateral comparison

Complications

  1. Nerve bottleneck syndrome between the calcaneus and plantar fascia
  2. Disorder in the lateral leg, SI joint or hip joint due to pain avoidance with shifting of force to the outer edge of the foot

Therapy

  • As a rule: spontaneous healing within max. 1 a; with conservative procedures healing in 90% of cases within 6 months. After 1 year, 1% remain with surgical need, which improves in 90% to 80% (even in athletes)
  • Taping
  • Radiotherapy
  • Take it easy, avoid frequent impact loads such as running; temporarily switch to shorter steps when walking; stop walking barefoot
  • Stretching the Achilles tendon, even better: stretching the plantar fascia itself. In a study with stretching as monotherapy, 72% showed improvement. Stretching at least 3/d
  • Insoles that cushion the heel, they mainly improve the function but less the pain
  • Leg splints that immobilize the foot at night without dorsiflexion, and thus without the possibility of further contraction
  • Massage: Cross-frictions at the base are unpleasant but pain-relieving
  • The efficacy of the frequently administered NSAIDs could not be proven
  • Local cortisone infiltrations (maximum once due to the risk of increased fat pad shrinkage and increased risk of rupture)
  • Platelet-enriched autologous plasma, still being tested, promising so far
  • Botox injections, still being tested, promising so far
  • Iontophoresis
  • Extracorporeal shock wave therapy, inconsistent study situation

DD

  1. Ankylosing spondylitis
  2. Reiter’s disease
  3. RA

Asana practice

In plantar fasciitis, the focus is on stretching the longitudinal ( intrinsic) plantar foot muscles and stretching the triceps surae and thus also preventing the Achilles tendon from tightening. The longitudinal plantar foot musculature consists primarily of toe flexors in the plantar direction. Accordingly, dorsal stretching of the toes in the metatarsophalangeal joints is one of the most important tasks. This can be achieved excellently with postures in which the toes point upwards on the wall while the sole of the foot stands on the floor in front of the wall, such as setu bandha sarvangasana with wall. Stretching these muscles with a small fascia roller is also very helpful. These should be performed at least three times a day, with sufficient pressure and for a sufficient length of time per area worked on. In addition to the intrinsic foot muscles, which are the active tension belt for flexing the foot, the passive tension belt, which consists of the affected plantar fascia and the plantar long ligament, is also stretched. Simply rolling the foot moderately over the fascia roller, on the other hand, can hardly fulfill more than an alibi function.

In addition to the plantar fascia and the intrinsic foot muscles, it is important to stretch the triceps surae, which is the main plantar flexor of the ankle (more precisely: the ankle joint) and therefore works closely with the tension belt system. The significantly weaker plantaris must also be mentioned here. Deficiencies in one system will not remain without consequences for the other in the long term. In the triceps surae, a distinction must be made between the monoarticular soleus and the biarticular gracilis. Therefore, stretches in the direction of dorsiflexion of the ankle must be performed both with the knee joint flexed (for the soleus) and with the knee joint extended (for the gracilis). Here you test and practice one or the other as required.

A lack of strength in the ankle-stabilizing muscles can also promote plantar fasciitis. Above all, all relevant muscles or muscle groups that are used with a certain minimum amount of force during the frequent activities of walking and standing must be considered. This does not usually include the foot lifts, as they only have a restoring function for renewed plantar flexion. Therefore, in addition to various types of common foot exercises, strengthening the plantar flexors, pronators and supinators of the ankle is particularly helpful.

Asana practice

In plantar fasciitis, the focus is on stretching the longitudinal ( intrinsic) plantar foot muscles and stretching the triceps surae and thus also preventing the Achilles tendon from tightening. The longitudinal plantar foot musculature consists primarily of toe flexors in the plantar direction. Accordingly, dorsal stretching of the toes in the metatarsophalangeal joints is one of the most important tasks. This can be achieved excellently with postures in which the toes point upwards on the wall while the sole of the foot stands on the floor in front of the wall, such as setu bandha sarvangasana with wall. Stretching these muscles with a small fascia roller is also very helpful. These should be performed at least three times a day, with sufficient pressure and for a sufficient length of time per area worked on. In addition to the intrinsic foot muscles, which are the active tension belt for flexing the foot, the passive tension belt, which consists of the affected plantar fascia and the plantar long ligament, is also stretched. Simply rolling the foot moderately over the fascia roller, on the other hand, can hardly fulfill more than an alibi function.

In addition to the plantar fascia and the intrinsic foot muscles, it is important to stretch the triceps surae, which is the main plantar flexor of the ankle (more precisely: the ankle joint) and therefore works closely with the tension belt system. The significantly weaker plantaris must also be mentioned here. Deficiencies in one system will not remain without consequences for the other in the long term. In the triceps surae, a distinction must be made between the monoarticular soleus and the biarticular gracilis. Therefore, stretches in the direction of dorsiflexion of the ankle must be performed both with the knee joint flexed (for the soleus) and with the knee joint extended (for the gracilis). Here you test and practice one or the other as required.

A lack of strength in the ankle-stabilizing muscles can also promote plantar fasciitis. Above all, all relevant muscles or muscle groups that are used with a certain minimum amount of force during the frequent activities of walking and standing must be considered. This does not usually include the foot lifts, as they only have a restoring function for renewed plantar flexion. Therefore, in addition to various types of common foot exercises, strengthening the plantar flexors, pronators and supinators of the ankle is particularly helpful.

Asanas

Asanas in 851: Stretching the plantar flex ors
Asanas in 852: Strengthening the plantar flexors
Asanas in 856: Stretching the gastrocnemius
Asanas in 857: Strengthening the gastrocnemius
Asanas in 971: Stretching the toe flex ors
Asanas in 972: Strengthening the toe flexors
Asanas in 861: Stretching the supinators
Asanas in 862: Strengthening the supinators
Asanas in 871: Stretching the pronators
Asanas in 872: Strengthening the pronators