Plantar Fasciitis

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Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of each foot and connects the heel bone to the toes, known as the plantar fascia.

Plantar fasciitis commonly causes stabbing pain that often occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.

Causes

The plantar fascia is a band of tissue, called fascia, that connects your heel bone to the base of your toes. It supports the arch of the foot and absorbs shock when walking.

Tension and stress on the fascia can cause small tears. Repeated stretching and tearing of the facia can irritate or inflame it, although the cause remains unclear in many cases of plantar fasciitis.

Risk factors

Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:

Age. Plantar fasciitis is most common in people between the ages of 40 and 60.
Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis.
Foot mechanics. Flat feet, a high arch or even an atypical pattern of walking can affect the way weight is distributed when you’re standing and can put added stress on the plantar fascia.
Obesity. Excess pounds put extra stress on your plantar fascia.
Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can be at increased risk of plantar fasciitis.

Complications

Ignoring plantar fasciitis can result in chronic heel pain that hinders your regular activities. You’re likely to change your walk to try to avoid plantar fasciitis pain, which might lead to foot, knee, hip or back problems.

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Clinic hours

Monday	8.00am – 5.30pm
Tuesday	8.00am – 6.00pm
Wednesday	8.00am – 5.00pm
Thursday	8.00am – 5.30pm
Friday	8.00am – 4.30pm

Paul Graham

Paul Graham has been using plantar pressure analysis as part of his clinical practice since first purchasing an Fscan Mat and in-shoe system in 1998. It was a steep learning curve to understand the information behind the pretty colours and what it means. This form of analysis was in its infancy in Australia, and the only way of gaining an appreciable understanding of what the data represented and how could be used in clinical practice was gained through regular email and phone contact with a number of American podiatrists who had been using the Fscan system for many years.

The most well-known of these practitioners is Dr Howard Dannenberg and through this relationship Paul grew to understand the relationship of sagittal plane movement and the importance of how the foot has a significant effect on the rest of the body. In fact Paul’s foundational knowledge of recording, data management and analysis came through Howard’s leadership and the plantar pressure case studies that were shared. This knowledge base was further augmented when Dr Bruce Williams DPM, a protégé of Howard’s training, visited Australia in 2004 and stayed with Paul in Geelong, working and training him in his clinic. In 2005, Paul was invited to Latrobe University to present on his clinical use of plantar pressure in the prescription of the orthotic correction design.

Up until this stage, Paul was combining evidence-based examination and video gait assessment with plantar pressure analysis and, through this orthotic manufacture. The issue was that each part of the assessment used different equipment. In 2006 Paul moved to the Milletrex system, (forerunner of the Freestep software and Sensormedica hardware) and as this combined all aspects of the diagnostic and manufacturing process, he moved to this system. Again a learning curve was required to become familiar with the different parts of the system, however planter pressure is planter pressure and as such, once you understand the recording and data management side, analysis can be done.

In late 2010, the Freestep software program was presented and the engineers in Italy were keen to make it the best on the market. Through the years there have been regular updates making the program more user-friendly and the data presentation more valuable and easy to understand. In fact at present Paul is working with Scott Sorenson and the Italian software developers to enhance this further so that areas of dysfunction and asymmetry are easily noted and measured,. This will be valuable for both the initial assessment and also to easily chart improvement at review appointments. This continued refinement and development, makes Freestep a very valuable clinical tool.

Plantar pressure analysis can only grow in significance as it shows objective data that the eye cannot see. This is now even more important with the discovery that vertical force,( that we describe as pressure), is what causes the overloading that results in tissue damage, rather than any angular anomaly such as an inverted heel or lowering of the medial longitudinal arch. Using Freestep enables Paul to chart improvement effectively and efficiently each visit by simply having a person walk over the mat or treadmill and comparing it to the previous visit; all within five minutes. This is then a record of the patient’s progress, valuable, not only to the treating clinician, but also to any third party who is paying for the treatment.

Video gait assessment is very, very helpful in understanding the biomechanics of the body in motion and should be used in conjunction with planter pressure analysis; however Paul’s clinical use of plantar pressure analysis has led him to the conclusion that it is superior in consistency, ease and speed.

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