A common debilitating injury affecting the foot is a condition known as Plantar Fascitis. The plantar aponeurosis or fascia is made up of strong bands of fibrous connective tissue, which originate on the heel bone or calcaneus and insert into the sides of the metatarsal heads at the base of the toes. The fascia surrounds the soft tissue structures of the sole of the foot and acts as one of the primary supports for the arch. The plantar fascia is often described as a "tie rod" for the arch as it serves to connect one end to the other and prevent "spread". The plantar fascia is subjected to many stresses and forces during physical activity, which may result in a strain/sprain and progress to inflammation in chronic cases. A small growth of bone on the bottom of the heel called a heel spur may or may not be present. There are cases of heel spurs occurring with no associated painful symptoms.
The pain associated with plantar fascitis first is most pronounced when putting weight on the foot such as getting out of bed first thing in the morning and walking after prolonged sitting. The pain will typically diminish during the activity and return after the activity and after stationary positioning. Plantar fascitis occurs primarily in active or athletic patients, however it can also occur from activities such as prolonged walking on cement warehouse floors, etc. The condition is very common in runners.
Physical therapy treatment
for plantar fascitis includes the use of anti-inflammatory modalities
such as ultrasound and iontophoresis along with soft tissue massage and
stretching. Arch supports or orthotics are helpful for those patients
with high or low arches or those that pronate or walk on the inner aspect
of the heel bone. Proper shoe wear is important. Modification of physical
activities can be addressed. Some simple self-treatment techniques include
massaging the bottom of the foot by rolling over a tennis ball and more
importantly stretching the foot toward the knee with the leg extended
(10 stretches holding 10 seconds) prior to getting out of bed first thing
in the morning.
If you have any additional
questions with regards to plantar fascitis, please feel free to call a
physical therapist at East Suburban Sports Medicine Center.
Donald M. Vargo, PT, ATC
One of the most common injuries in the active/athletic population is the ankle sprain. The injury typically occurs when weight bearing (i.e. running or walking), and the foot is pointed away from the knee followed by the ankle rolling outward. The sprain can also happen if the ankle and leg are rolled on – such as a football pile up. The resulting injury can range from mild to severe.
The ankle joint is formed by the two lower leg bones, the larger tibia on the inside and the smaller thinner bone, the fibula running down the outside. The two bones form a dome, which holds the talus bone of the foot. Strong thick ligaments connect the bones, covered by a sleeve, or capsule. When the ankle rolls outward, the ligaments can be stretched or torn, resulting in varying degrees of pain, internal bleeding, and swelling around the ankle joint. Sprains are graded as 1 or mild, 2 or moderate, and 3 being severe and involving more ligaments.
Treatment for ankle sprains is extremely important in the first few days to minimize swelling. Crutches can be used initially. Pressure in the form of a foam horseshoe and ace bandage, along with ice and elevation (higher than the heart) are essential for the first 48-72 hrs. Physical therapy treatment should begin as soon as possible to include whirlpool, electrical stimulation, JOBST compression, massage, and progressive weight bearing to reduce the swelling and promote healing.
Once the acute phase is managed, treatment continues along with the addition of exercise for range of motion, strengthening of the ankle muscles, and proprioception (fine tuning agility) exercises to return to physical activity. An ankle sprain will feel better long before the strength and proprioception are back to normal. It is important to continue with a home exercise program for a few months to prevent reoccurrence and additional ligament damage. In some cases, ankle bracing and or ankle taping is effective in allowing return to activity or sports.