can be difficult to find footwear that provides adequate support for high arches, which can cause strain and inflammation (see below). Exercise 4 Make a wet-blot print of your foot to determine the height of your arches. For this exercise, you will need a few blank sheets of printer paper and a washcloth or hand towel large enough to cover the entire sole of your foot. Wet and wring out the washcloth or towel, then place it down on a hard surface floor. Place one of the sheets of paper next to it. Press your bare foot into the wet washcloth, lift it, and then press it onto the sheet of paper to make a blot of your footprint. (If you do not get a good blot footprint, you may have to make the washcloth wetter.) Look at the blot footprint that your foot made and notice the width of the blot where your arch would be. Is it very narrow, indicating a high arch that made little to no contact with the floor? Or, is it very wide, indicating a flatter foot? Make blot prints of both feet and compare them to each other. Are they similar, or different? If they are different, has there been an injury to one of your feet or ankles, and how does the blot print of that foot look different? Poor support and footwear Footwear choices can also have a significant effect on the health of the plantar fascia, especially if there is not consistent and adequate support for the health of the feet. Most physicians caution patients who have suffered from episodes of plantar fasciitis from ever going barefoot, even indoors at home, because of the lack of support and the way the foot can pronate when the arch is completely unsupported. Shoes that offer very little arch support may also cause similar problems, like the popular ballet flats or flip-flops, especially if they are worn while standing or walking for long periods of time. As mentioned above, runners can experience bouts of plantar fasciitis when their running shoes are worn out. “To prevent heel pain, replace old shoes with excessive or uneven wear on soles and heels. Replace athletic shoes every 350 to 500 miles. To test the support of the heel, press the sides of the sneaker together and make sure they do not collapse” (Mitchell, 2017). Wearing high-heeled shoes, as is the expectation for many professional women, can also be problematic because of the tightness this can create in the muscles of the calf. When the heel of the foot is excessively elevated, the gastrocnemius and soleus are engaged. This is because the primary function of these muscles is to move the ankle into plantar flexion. When high heels are worn every day, the calf muscles can become chronically hypertonic. This can dramatically limit the ability of the ankle to move into dorsiflexion. As we learned above, limited dorsiflexion is one of the primary causes of plantar fasciitis. For jobs or other activities that require standing for long periods of time, shoes that provide adequate foot support can provide a protective barrier between the plantar fascia and the constant impact of the hard surface beneath it. Age Although plantar fasciitis can strike at any age, the most common age group to seek medical care for this affliction is between 40 and 65 years old. The medical community believes age as a risk factor is primarily because of the degenerative processes of aging. As we age, the fat pads on the heels of the feet become thinner, thus providing less of a cushion for the soles of the feet—right at the location where the plantar fascia attaches to the calcaneus. The production of collagen also diminishes with age, as does the elasticity of the body’s connective tissue, so there is less ability for the body to repair minor damage to the plantar fascia. A condition called “fallen arches,” or “adult- acquired flat foot,” which is a dysfunction of the posterior tibial tendon, is an age-related problem and can also be a contributing factor to inflammation of the plantar fascia. The posterior tibial tendon is responsible for creating and
many hours on concrete surfaces. Additionally, jobs that require frequent use of ladders can tighten the calf muscles and irritate the plantar fascia. The activity risk factors do not necessarily have to be sports; rather, they can be any activity that is frequent and repetitive. Decreased ankle dorsiflexion Decreased dorsiflexion in the ankle is considered to be the most common risk factor for plantar fasciitis. This can also be common in runners and other athletes. One study found that people who had 10 degrees or less of dorsiflexion had an odds ratio of 23.3 of having plantar fasciitis, when compared to the group of people who had 10 degrees or more of active dorsiflexion (Riddle, 2003). There are several causes for decreased dorsiflexion: Injuries to the ankle joint itself and subsequent scar tissue can create a dysfunction in the joint that limits the range of motion. Excessively tight calf muscles, especially the gastrocnemius, can be a contributing factor. The primary function of the calf muscles, such as the gastrocnemius and soleus, is to move the ankle into plantar flexion. This is typically a stronger action than dorsiflexion, making them the naturally dominant muscle group. When they become hypertonic, the calf muscles can inhibit dorsiflexion. While tight calves are commonly seen in runners, women who frequently wear high-heeled shoes can also develop hypertonicity in the gastrocnemius muscles. Injury to the Achilles tendon, especially the scar tissue that develops from a healed rupture, can dramatically limit the range of motion in the ankle. Whatever the cause, the effect of an increased risk for developing plantar fasciitis is the same. Body weight Carrying excess weight puts an obvious strain on the feet. This strain can especially occur on the plantar fascia because of its function as a shock absorber. But what is considered excess weight? “If your Body Mass Index (BMI) is between 25 and 29.9 you are considered overweight. If your BMI is 30 or over you are considered obese” (Medical News Today, 2016). Studies show that obese people are more likely to develop plantar fasciitis due to the additional strain placed on the plantar fascia from both the excess weight bearing down on the feet and the abnormal weight distribution on the sole of the foot. Excess weight and obesity can also cause deviations to a normal gait, in which the weight of the body is consistently applied to the sole of the foot in an unbalanced way. This affects the normal function of the plantar fascia. Pregnant women also present with acute episodes of plantar fasciitis in late pregnancy because of both the strain of the excess weight, as well as the awkward distribution that the body weight can put on their feet. Flat feet “Flat feet” is the common term used to describe feet with little to no longitudinal arch. Flat feet can be caused by genetics, making them a condition since birth. Or, this condition can occur over time as a degenerative process or as the result of an injury. It can also be a secondary effect of a musculoskeletal disease, like muscular dystrophy. Whatever the cause, the body’s natural support system for the sole of the foot is compromised in cases of flat feet. Those who have them can be prone to developing plantar fasciitis. The rubber band-like tension of normal plantar fascia becomes significantly decreased or absent in the case of flat feet. A study conducted in Taiwan and published in 2004 showed that “In the flexible flatfoot group, 10 of 23 patients (43.4%) had plantar fasciitis, but only two subjects (8.7%) in the normal arch group had plantar fasciitis” (Huang, 2004). However, the exact reason for the increased risk remains unclear. High arches Although not as thoroughly researched as the incidence of flat feet with plantar fasciitis, some studies have found that having very high arches can also be a precursor to developing plantar fasciitis. Flat feet and high arches are both structural abnormalities of the feet that can affect the normal function of the plantar fascia. In the case of high arches, there is too much rubber band-like tension in the plantar fascia. Additionally, it
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