Plantar fascia is a thick connective tissue extending from calcaneal to metatarsal heads. It has 3 bands: lateral, medial, and central.

Source: http://theuniquetouchmassage.massagetherapy.com/plantar-fasciitis-anatomy.gif

The plantar fascia has a static and dynamic purpose whereby the static is to support arch foot in weight bearing. The dynamic purpose is to elongate and elevate the medial arch which is also known as the windlass mechanism (elevate the medial arch with dorsiflexion of big toe).

What is Plantar Fasciopathy?

Plantar fasciopathy is a foot condition that is primarily due to repetitive micro tears of the plantar fascia similar to tendinosis or tendinopathy. The term plantar faciitis is more appropriate for the acute, inflammatory phase but most clinicians have been using it for acute and chronic phase. There are 2 Phases of damage:

• Inflammation phase, which has acute symptoms
• Degeneration phase which is the chronic stages

The inflammation and tearing commonly occur near the origin of the central band at the medial calcaneus (the heel area). It is believed to be due to poor foot biomechanics that stress the plantar facia. Flat feet or weak foot arch muscles are the common causes of this condition. Patients usually experience tenderness around the heel and arch area. There also may be pain with standing on the toes or bending toes backwards. An increase in weight, age or activity levels could increase the risk of plantar fasciopathy.

How is it managed?

This condition is most commonly treated with stretching, strengthening exercises, ultrasound, strapping, orthotics, night splints and joint mobilisation. Plantar fascia and calf stretches has been shown to be effective whereby the improvements of symptoms persisted for months (Rompe et al., 2010). Therefore, night splints could be beneficial in some individuals as there is a constant stretch of the plantar fascia.

Furthermore, orthotics were found to improve pain and function in conjunction with exercises for those in the acute or chronic stage. Strapping whether with rigid or kinesio tape has a positive short –term effect for plantar fasciopathy. However, these interventions combinations and techniques has to be modified according to each individual patient. A good thorough subjective and objective assessment would be required to treat this condition effectively.

By: Sarah Kew

Disc herniation or commonly referred to as a ‘slipped’ disc occurs when the discs between the joints crack and leak out the gel material. This disc material could encroach onto the nerve roots in the spine and eventually compress it, causing pain and neural symptoms. The disc could also dehydrate and shrink, narrowing the joint space. This can then cause bone spurs to develop on the vetebra which could be painful (also called stenosis). These changes contribute to the narrowing of the spinal canal/foramen which could lead to increased pressure on the nerve.

Some of the symptoms include but not limited to are:

• Neck pain that radiates to the arm
• Shoulder pain
• Numbness or tingling down to arm and fingersWeakness in the arm
• Sharp or burning type pain

Causes

• Cervical herniation develops from wear and tear of the disc. In time, the disc loses its elasticity and could crack and cause the gel material to leak out
• This can then put pressure onto the spinal nerves also known as radioculopathy, causing neural symptoms or pain.
• Joint space narrowing can increase friction and stress between joints leading to formation of osteophytes (bone spurs).

Source: www.hcahealthcare.co.uk

Conservative Treatment:

Studies support conservative intervention such as cervicothoracic stabilisation program, McKenzie’s approach, and manual therapy. Some of the physiotherapy treatments used are:

• Joint mobilisations to improve stiffness. Improving flexibility can prevent further repetitive microtrauma from poor movement patterns.
• Soft tissue release for stiff muscles around the neck. Shoulder muscles often stiffen up with this condition
• Exercise program to strengthen the muscles and improve flexibility. Strengthening the muscles of the neck could help relieve symptoms in the long term as the muscles would help support the neck, reducing the pressure onto the disc/joint.
• Postural correction
• Activity modification. Heavy lifting and certain sports could add stress on the joint and exacerbate the condition
• Cervical traction to gap the joint

There are surgical interventions used to treat disc degeneration problems such as artificial disc replacement, spinal fusion and discectomy. However, there are many possible risks and complications associated with surgical interventions. Therefore a conservative approach is recommended in the initial phase and surgical interventions should be considered only if there are no improvements.