IMP.

IN ORTHOPAEDICS SHORTS BY MPMEP

PLANTAR FASCITIS AND CALCANEAL SPUR

1. Plantar fascitis
Summation of a series of micro-trauma to the plantar
fascia due to sustained stress of weight bearing hopping,
jumping or running results in fascitis.
During the first 15 percent of the gait cycle, the foot
is subjected to pressure as much as 120 percent of the
body weight. This load on thefoot is supported by the
passive structures (bones and ligaments) alone as the
intrinsic muscles come into ac tion only around 30 percent
of the gait cycle.
Therefore, the maximum stress of the body weight falls on
the ligaments and plantar fascia. Significant stress falls
on the plantar fascia in stabilising the foot firom heel
raise to toe-off phase of gait again when the
metatarsophalangeal joints are extended.
Repeated stress of this nature causes plantar fascitis.
Pain is felt over the inner aspect of the sole or heal
in all weight bearing situations. Tenderness is usual
noticed at the inner part of calcaneus, the site of origu
of plantar fascia. Pain is relieved as soon as weight b
aring is discontinued.
2. Calcaneal spur :
Continued overstrain of plantar fascia results in strip-
ping of periosteum from its origin at the calcaneus. The
gap thus formed is filled up by proliferation of bone,
resulting in formation of a bony spur to secure the
detached attachment. Thus, calcaneal spur is a late se-
quelae of plantar fascitis. The calcaneal spur may not
always be painful. Once formed, this spur is permanent;
and attempts to remove it result in its recurrence.

COMMON MANAGEMENT FOR BOTH CONDITIONS

PLANTAR FASCITIS & CALCANEAL SPUR
Strengthening exercises to the intrinsic muscles, as
sustained toe curling, performed even with shoes on,
provide an excellent technique of resistive exercise.
Sessions of holding the contracted position inside the
shoe several times a day are very effective provided
they are done at frequent intervals within the level of
discomfort.
The basic aim of treatment is to:
1. Reduce pain and inflammation by taking off the
imitating focus of the strain of weight bearing (e.g. heel
raised walking while getting down from bed in the
morning or after long sitting).
2. Relieving strain from the fascia by providing an
appropriate wedge in the shoe. This helps in lessening
the angle between the hind foot and forefoot, and
relaxes the fascia. This is done by adjusting the height
of heel to a minimal level at which the pain disappears.
The UC-BL shoe insert has proved very effective. This
Stoe insert reduces tension and constant irritation of
he inflamed fascia and also provides an alternative to
elevate the foot arch.
Elongated soft heel pad or well padded medial arch
support covering the longitudinal arch is occasionally
effective.
3. Faradism can be an effective measure to induce
contractions in the intrinsic muscles; improving their
tone, power and circulation.
4. Exercises to the intrinsic muscles in warm water
in the morning before initiating weight bearing are use-
ful in lessening the morning pain.
rence
5.It must be emphasised that the patient performs
these exercises for several short sessions during the
day.
6.Slow barefoot walking on the lateral border of foot
with cupping of the foot by curling of toes is effective
in moulding longitudinal foot arch. It can be made ef-
fective by repeatedly doing this exercise with the shoes
on in standing, walking as well as sitting.
7.Sarbo-rubber heel pad provides better relief in
patients with calcaneal spur.
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..............................by
meenakshiputraeashwarprasad.19@gmail.com