i guess the pain response has everything to do with the behaviour of soft tissue lesions, where pain is usually felt when the muscles are cold and subsides with teh warm up effect. The pain is usually worse on rising and when taking the first few steps, and subsides after a few minutes. I guess with walking the plantar fascia warms up and beomes more elastic with less resistance to stretch. I guess the same happens when one sits for a prolonged period, the fascia shortens and becomes painful when walkiing( stretching). I advise my patients to do some foot exercises and stretching before getting out of bed and before standing up .this usually helps. A study done a few years ago on the use of foot splints at night( in dorsiflexion) has shown to reduce the symptoms of plantar fasciitis. 
( an observation that heavy bed clothes keeps the foot in plantarflexion, which shortens the fascia, and causes more pain when the fascia is stretched on walking)
 regards
 
Neil Viranna
Physiotherapist
Durban, South Africa
----- Original Message -----
From: [log in to unmask]>Dr. M. P. Shrivastava
To: [log in to unmask]>[log in to unmask]
Sent: Tuesday, November 06, 2001 3:56 AM
Subject: ,

Dear Sir/Madam,

Could someone explain me why the patients suffering from Plantar Fasciitis do get maximum pain after  getting from the bed and while start walking after sitting for a while ?

Dr. M. P. Shrivastava
Orthopaedic Surgeon
Kathmandu, Nepal
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