Plantar Fasciitis or Plantar Fasciosis?
Plantar fasciitis is a painful condition of the foot which results from small tears within the plantar fascia. The plantar fascia is a thick, connective tissue band that originates on the bottom of the heel bone and extends to the ball of the foot. The high density composition of collagen fibers give the fascia it’s strength and it’s ability to support the the substantial amount of force through the arch when walking. The collagen fibers within the fascial band are oriented lengthwise, running parallel from the heel to the toes. Due to the mechanics of the foot, the portion of the fascia which attaches to the inside of the heel bone is placed under the most stress when walking. This area is also the most common area for injury. Injury to the plantar fascia occurs when the force on the fascia exceeds it’s capacity to support the load on the foot. The fascia develops small tears when it is under excessive stress, similar to a rope fraying when it is under tension. Each small tear weakens the fascia and increases the susceptibility to further injury. The condition most commonly develops over a period of weeks, but can occur acutely. As with any injury, the body immediately attempts to repair the injured tissue. The repair process involves an initial inflammatory phase as the body increases blood flow to the injured area and sends cells to repair the damaged tissue. The inflammatory phase in musculoskeletal injuries lasts approximately 6 to 7 days. The next phase of healing is the reparative phase and this phase overlaps with the inflammatory phase. The reparative phase of healing generally lasts for 2 to 3 weeks. During this phase, new collagen fibers are produced to bridge the area of the fascia which was torn. The collagen fibers are laid down in a random configuration and do not reflect the fascia’s original collagen arrangement. The next phase is the remodeling phase and this phase may take many weeks to months to complete. The remodeling phase involves organization and alignment of the collagen fibers, which eventually leads to an increase in strength of the plantar fascia.
When plantar fasciitis is diagnosed and treated early, the phases of healing are allowed to progress naturally and the condition heals uneventfully within a few weeks. Unfortunately, the majority of plantar fasciitis cases are not diagnosed early. The microtears in the plantar fascia may cause little pain initially and the injury is commonly ignored. It is difficult to minimize stress on the fascial band because it is stressed with every step and most people take 5,000 - 10,000 steps a day. Continued walking aggravates the injured tissue, causing repetitive stress on the plantar fascia, resulting in more tearing and continued inflammation. When the inflammatory phase is prolonged, it is no longer beneficial and interferes with the reparative process of healing, initiating a degenerative process. The fascia starts to deteriorate and weaken as the collagen fibers become disorganized and fragmented. Fewer blood vessels bring cells to aid in healing and the fascia thickens in response to continued stress. The term to describe this condition is plantar fasciosis. The suffix “osis” means degenerative, whereas “itis” means inflammation. At this point in the process, the condition is no longer an inflammatory condition and is considered a degenerative condition. Plantar fasciosis is much more difficult to treat when diagnosis is delayed and therapy is not initiated immediately.
Christine Dobrowolski, DPM is a podiatrist and owner of Northcoast footcare, Inc an online resource for foot care products and foot health information. More information, images and detailed treatment instructions for plantar fasciitis and plantar fasciosis.
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