From: lpc@dickens.com (Luis P Caamano)
Subject: Re: Plantar Fasciitis
Date: Mon, 25 Jan 1993 03:43:55 GMT
Organization: Dickens Data Systems, Inc.

In article <1993Jan25.022708.19716@dickens.com> lpc@dickens.com (Luis P Caamano) writes:
>In article <1993Jan22.143155.41820@ux1.cts.eiu.edu> cfthb@ux1.cts.eiu.edu (Howard Black) writes:
>>
>>    The thing about PF is that it is more a symptom than a primary injury;
>>that is, it results from some kind of biomechanical problem that, if not
>>corrected, will cause PF again.  
>                       ^^^^^^^^
>And more than that will produce a heel spur which is so painful you
>can hardly walk and more than often requires surgery.  What happens is
                     ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
I was wrong here, it's the other way.  So, to compensate for my mistake  
I'm including the article I got the information from.

Of course, reprinted without permission (ala usenet)

PLANTAR FASCIITIS
Causes and Precautions
By Perry Julien, D.P.M.  (Atlanta Foot and Ankle Center)
-----------------------

  Many of the 40,000 runners who will be participating in this
year's Peachtree Road Race have suffered from injuries related to
their running that have caused them to alter their training
activities in one way or another. One of the most common
injuries seen in athletes is plantar fasciitis.

  Plantar fasciitis is an inflammation of the band of tissue on
the bottom of the foot.  It extends from the calcaneus (heel
bone) to the base of the toes and functions to support the arch of
the foot.

  This seemingly minor injury affects both novice and elite runners
as well as people that spend a lot of time on their feet.  It can
cause significant pain and dissability if left untreated.

  Plantar fasciitis can occur from over-training, running on hard
or irregular surfaces, and from structural or biomechanical
abnormalities affecting the foot and leg.  In general, both high
arched and pronated feet are prone to this injury.

  Pronation is a rolling in or flattening of the arch that occurs
during walking or running.  Pronation helps provide shock
absorption for the foot and leg but when it becomes excessive it
can be responsible for many lower extremity injuries including
plantar fasciitis.

  A high arched foot can also develop plantar fasciitis, however
the mechanism of injury in these cases is usually increased
stress of the arch due to a relatively inelastic plantar fascia. 

  Plantar fasciitis is the result of repeated stress or
microtrauma to the plantar fascia where it inserts into the heel.
Over time this microtrauma will cause small tears in this tissue
leading to heel and/or arch pain.  At first the pain will occur
when taking the first few steps after getting out of bed in the
morning.  This pain is often described as feeling like "a stone
bruise" and will usually go away after walking for a little
while.  As the injury becomes more severe the pain may be present
anytime one stands or walks.

  Over a long period of time the chronic inflamation that results
from this repeated stress may cause a bone spur to form on the
bottom of the heel.  This is commonly known as a heel spur.  In
most cases, however, it is not the spur that is causing the pain,
but rather the pulling on the fascia.  Rarely, if ever, is
surgery indicated for this problem.  There are also other
conditions that can affect the heel such as stress fractures and
bursitis that can cause pain similar to plantar fasciitis.

  Plantar fasciitis can almost always be treated by conservative
means.  The first step is to reduce the inflammation in the heel
and arch area.  This is accomplished by rest, ice application,
and the use of an arch strapping to take the stress off the
plantar fascia.  Depending on the severity of the symptoms oral
anti-inflammatories or injection thrapy may be recommended.
During this period of recovery it is not necessary to stop all of
your fitness activities.  The use of alternate training such as
cycling, swimming, or running in a pool with a flotation device
can allow you to maintain your current level of fitness.

  It may take up to four weeks for the pain and inflammation to
subside.  During that time it is important to determine why the
injury occurred .....  (can't read last sentence of the
paragraph). 

  When an overuse injury occurs due to the overzealous training,
the best approach to avoid re-injury is to adjust your training
schedule appropriately.  However, in many cases you will
recuperate from an injury only to have a reoccurrence in a few
months.  In these situations the cause is often related to some
type of biomechanical or structural abnormality in your lower
extremity.

  One of the most frequent causes of overuse injuries of the lower
extremity including plantar fasciitis is tightness in the calf
and achilles tendon.  The achilles tendon is made up of two
muscles groups, the gastrocnemius and soleus, which join together
2/3 of the way down the leg to form the strongest tendon in your
body.  A tight achilles tendon prevents the ankle from bending up
properly to a degree necessary for walking and running.  The lack
of this motion causes the arch of the foot to collapse in or
pronate to make up for this lack of motion.  A leg length
difference, tight hamstrings, and certain foot structures can
also cause excessive pronation to occur.  As the foot
over-pronates it also causes the arch to stretch resulting in the
microtrauma previously discussed.

  An important part of the long-term treatment of plantar fasciitis
is to develop flexibility in the calf area.  Many different
stretches have been suggested for this part of the body, however
foot placement and proper techniques are essential in achieving
good results.  Recently a device called the Foot-Flex(tm) has
been introduced to aid in correct postioning of the foot and leg
to stretch the calf and arch.  Stretching is a gradual process
and should be performed slowly and on a regular basis to be
effective.

  When abnormal foot structures or biomechanics are contributing to
your injury, your doctor may recommend the use of prescription
orthotics to be worn in your shoes.  This should only be done
after thorough biomechanical examintaion, and a walking and
running evaluation.

  Orthotics are custom made shoe inserts that help to correct
imbalances in the foot and leg.  They accomplish this by
realigning the feet in a "neutral" postion to allow the bones,
muscles, and tendons to function more efficiently.

  Orthotics devices are constructed from various materials and are
designed to your specific needs depending on your injury and the
type of activities in which you participate.  They are not the
answer to every problem but when indicated they can be extremely
effective in the treatment and prevention of many injuries.

  The best prevention for overuse injuries such as plantar faciitis
is to evaluate your training schedule so that you increase your
activity gradually.  Also, take the time to stretch everyday even
when you do not workout, and warmup correctly before activity.

  Many minor injuries will resolve in a few days with rest and ice.
However, anytime you sustain an injury that persists for longer
than a week, gets worse, or reoccurs, you should see a
sports-oriented physician for a thorough examination and
appropriate treatment.

      Dr. Perry H. Julien, D.P.M. specializes in the medical and
      surgical tratment of foot and ankle problems and sports
      medicine of the lower extremity.
-- 
Luis P. Caamano                        |         lpc@dickens.com
Dickens Data Systems, Inc. Atlanta, GA |         uunet!dickens.com!lpc
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