Plantar Fasciitis

FAQs on Plantar Fasciitis

 

Plantar fasciitis forces about 2 million Americans to seek treatment every year. Common to occur in athletes, the obese, soldiers and those between 40 and 60 years, it accounts for 80% of patients treated for foot pain. The painful disorder impacting the underside of the foot causes heel pain in at least 10% people during their lifetime.

What is plantar fasciitis?

Plantar fasciitis is a painful condition associated with the inflammation and pain in plantar fascia, which spans like an arch across the underside of the foot. The thick band of fibrous tissue connects the heel bone with toes. Structural breakdown, scarring, inflammation, or injury causes swelling and weakness in this connective bottom arch of the foot resulting in hurting pain in the heel. The painful condition is best observed in the morning with sharp pain forcing patients to limp until the plantar fascia softens allowing increased foot motion.

What are the symptoms of plantar fasciitis?

  • Sharp pain in the heel or sole of the foot
  • Pain subsides with walking a few steps
  • Stiffness in the heel
  • Worsening heal pain and stiffness in the morning
  • Pain and stiffness in the heel when standing after prolonged sitting
  • Redness or tenderness in the heel

How does it occur?

Plantar fasciitis occurs when plantar fascia is hurt, strained, weakened, or pressurized beyond its ability to withstand. The thick band of fibrous tissue acts as a shock absorber arch in the foot. Originating at the heel bone, it runs along the sole of the foot cushioning and sustaining the underside arch.

When planter fascia is subject to stress and strain repeatedly, it becomes sprained, weak, inflamed, or injured. This may also cause swelling or even tears appear on the connective ligament. Frequent injuries and tear run the risk of structural breakdown of planter fascia. All these result in pain in the heel or sole, as patients walk or stand.

In athletes, plantar fasciitis is often traced to either tight calf muscles. Regular stretching workouts tighten up calf muscles and tendons. When they run or participate in high-velocity activities, calf muscles overstretch the connective ligament beyond its flexibility and strain it overreaching the optimum strength level. This leads to plantar fasciitis pain.

Degeneration of planter fascia with age also causes loss of elasticity and thickening of planter fascia. As a result, the connective ligament feels the heat whenever pressurized to expand. This causes onset of plantar fasciitis pain.

What causes plantar fasciitis?

  • Injury to plantar fascia causing inflammation or tears
  • Degeneration of plantar fascia
  • Calcium deposits constricting plantar fascia
  • Tears or swelling constricting collagen fibers in plantar fascia
  • Too much stress on plantar fascia due to walking style or physical activities
  • Wearing footwear without adequate arch support or cushioning
  • Obesity causing excessive weight on the foot arch
  • Walking style or twisting exerting too much pressure on the plantar fascia
  • Bone spurs in the heel bone
  • Achilles tendons

Who are at the risk of plantar fasciitis?

The risk of plantar fasciitis is associated with various factors, such as

  • Age: Middle aged between are at increased risk.
  • Nature of foot use: Athletes, dancers, and soldiers are at the enhanced risk of having plantar fasciitis due to their frequent foot use. Standing on a hard surface for long durations also add to the risk. Teachers, factory workers, and runners also face the threat as they have to stand for long hours or engage in activities highly likely to stress plantar fascia.
  • Exercises: Workouts causing stress or strain to the heel or the connective tissue also promote onset of plantar fasciitis.
  • Foot mechanics and shoes: Walking style or shoes without adequate cushion or arch support cause stress and strain that can hurt plantar fascia.
  • Obesity: Excessive weight gain increases the risk of pressure and stress that may injure plantar fascia.

How is plantar fasciitis diagnosed?

The diagnosis process includes physical examination and x-ray, if required. An assessment of symptoms is critical to know the painful condition. Doctors also analyze the condition in the light of age, occupation, physical health, risk of plantar fasciitis, and possible foot injuries. Patients may be asked about tenderness, stiffness, pain, and movement problems impacting the heel, sole, and the foot. X-ray is an option to identify if there are spurs in the heel bone or damage to the plantar fasciitis and surrounding areas.

What are the treatment methods available for plantar fasciitis?

  • Rest and Self-Care: Allow your foot sole and heel ample rest from any strenuous activity causing strain to planter fascia. A healthy weight, life-style changes, and avoiding high-impact sports help reduce stress on it saving from further sprain or inflammation. Apply ice or heat pads and do stretching regularly for a few days.Refrain from walking on hard surfaces barefooted. Avoid high-heel shoes while considering shoes with adequate cushioning and arch support.
  • Medications: You can use NSAIDS, ibuprofen, or other pain relievers prescribed by your doctor. These medications help alleviate inflammation and pain.
  • Occupational Therapies: Physiotherapy, including planter fascia stretching workouts, calf-muscle exercises; acupressure also helps relieve the foot arch from stress and tension; regular foot massage also relieves pain and comforts the arch.
  • Surgery Treatment: The procedure includes separating the plantar fascia from the heel so that there is no painful inflammation when it is stressed. If x-ray indicates heel bone spurs as the cause of planter fasciitis, surgery is done to remove spurs from the bone. However, surgery is only for those cases where all other treatment options are unable to reduce acute pain.
  • Assistive Devices:
    • Night splints to prevent morning plantar fascia pain
    • Heel cups for cushioned support to heels
    • Orthotics for enhanced support for arch and sole of the foot
    • Wraps to take pressure off from the heel or arch
  • Corticosteroid Injections: These steroid injections provide semi-permanent relief by reducing pain and inflammation.
  • Prolotherapy: Injections containing stem cells or platelet rich plasma harvested from patient’s bone marrow activates the natural healing process in the plantar fascia. It creates new cells that replace the damaged cells in the structure restoring it to its original strength.
  • Extracorporeal Shock Wave Therapy: Mild sound waves directly administered to the organ revives its self-healing ability when planter fasciitis does not respond to conventional therapies. A 2013 report cited findings of seven research studies to highlight the efficacy of the therapy to treat planter fasciitis pain.

 

References

American Orthopaedic Foot & Ankle Society 

American Association of Orthopedic Surgeons

Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP. (November 2013). “Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs”. Clin Orthop Relat Resl 471 (11): 3645–52.

Raymond R. Monto, Platelet-rich Plasma and Plantar Fasciitis, Sports Medicine and Arthroscopy Review, Volume 21, Number 4, December 2013;220–224

Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW (June 2014). “Plantar and Medial Heel Pain: Diagnosis and Management”. The Journal of the American Academy of Orthopaedic Surgeons 22 (6): 372–80

Cole C, Seto C, Gazewood J (December 2005). “Plantar fasciitis: Evidence-based review of diagnosis and therapy”. American Family Physician 72 (11): 2237–42.

Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ. Jul 19 1997;315(7101):172-5.

Sammarco GJ, Helfrey RB. Surgical treatment of recalcitrant plantar fasciitis. Foot Ankle Int. Sep 1996;17(9):520-6

Lee SY, McKeon P, Hertel J (February 2009). “Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis”. Phys There Sport 10 (1): 12–8

 

 

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