What Is Plantar Fasciitis?
The plantar fascia is the fibrous tissue that runs in the bottom of the foot from the heel bone to the toes. This ligament absorbs shock while walking and supports the arch in the foot. However repeated stress to the heel can cause small tears in the tissue, resulting in inflammation which is called plantar fasciitis. The foot consists of 28 bones, 33 joints, and 100 muscles, even more, of which support the plantar fascia and also help in shock absorption. The stress on the heel can be caused due to repeated force from sports that involve running and jumping, wearing high heels, and work that requires continuous standing or walking. It is more common in people who are overweight, and people with flat feet.
Plantar fasciitis usually causes stabbing pain as soon as the feet hit the floor in the mornings. The pain reduces once one starts walking but often returns if one strains the heel a lot.
What Are the Signs and Symptoms of Plantar Fasciitis?
Following are the signs and symptoms of plantar fasciitis -
- Pain is present on the bottom of the heel.
- Pain on the arch of the foot.
- Stiffness.
- Tenderness.
- Swollen heel.
- Pain is present every morning.
- Continuous moving activity induces pain.
The pain and tenderness are experienced at the sole and heel. The pain is worse in the morning when a person stands up after sitting for a long, and after exercising. The pain makes it difficult for a person to walk or run, and can sometimes make the feet feel warm and swollen.
Overuse of the foot even after developing signs of plantar fasciitis can cause the plantar fascia to rupture, which may result in local swelling, acute sole pain, and clicking or snapping sound.
What Are the Causes of Plantar Fasciitis?
Repetitive strain injury to the fascia of the sole causes plantar fasciitis. This strain injury can be caused by:
- Excessive walking or running.
- Walking barefoot on hard surfaces.
- A shock from jumping and landing on the feet.
- Long periods of standing.
- Obesity.
- Continuous use of high-heeled shoes.
- Inward rolling of the foot while walking or running.
- Tight Achilles tendon.
- Heel Spurs - Bony outgrowth near the heel where the ligament attaches.
- Some other conditions that can cause foot and heel pain are osteoarthritis, ankylosing spondylitis, reactive arthritis, and heel pad syndrome.
What Are the Risk Factors for Plantar Fasciitis?
While plantar fasciitis can occur without a clear cause, several factors can raise the risk of developing this condition, including:
- Age: Plantar fasciitis is more prevalent among individuals aged 40 to 60.
- Specific Types of Physical Activity: Activities like long-distance running, ballet, and aerobic dance that strain the heel and its connecting tissue can contribute to plantar fasciitis.
- Foot Biomechanics: Flat feet, high arches, or an abnormal walking pattern can alter weight distribution while standing, leading to increased stress on the plantar fascia.
- Obesity: Excess weight adds pressure to the plantar fascia.
- Occupations Involving Prolonged Standing or Walking on Hard Surfaces: Jobs such as factory work or teaching that require extensive time on the feet can elevate the risk of developing plantar fasciitis.
What Are the Complications of Plantar Fasciitis?
- If left untreated, one might develop chronic heel pain, which can change the way one walks. This may put abnormal loading at the ankle, knee, and hip joints and later on can cause pain in these joints too.
- In some cases, the plantar fascia can become irritated and thick and result in chronic foot pain called plantar fasciitis.
What Are the Ways to Diagnose Plantar Fasciitis?
After physically examining, the doctor will make sure that some other foot problem is not the cause of pain. The doctor may press the heel which may replicate the pain that a person had.
The doctor will then check the reflexes, muscle tone, sense of touch, coordination, and balance, to evaluate the muscle strength and nerve health. If needed, the doctor might suggest getting an X-ray or an MRI scan to rule out any fracture or other pathology that might cause heel pain. To diagnose plantar fasciitis, no investigation is needed. If an X-ray of the heel is done, it can show a bone spur that is formed as a result of chronic inflammation.
What Are the Treatment Modalities for Plantar Fasciitis?
The following are the treatment options:
- Medications:
- Painkillers like Ibuprofen and Naproxen sodium.
- Steroid or platelet-rich plasma (PRP) injections at the tender point.
- Home Remedies:
- Apply ice packs for 15 to 20 minutes, 3 to 4 times a day.
- Lose weight to reduce stress on the foot.
- Avoid wearing high heels.
- Avoid walking barefoot on hard surfaces.
- Wear shoes with moderate heels and good shock-absorbent properties.
- Avoid sports that require walking and jogging and switch to swimming or cycling.
- Do plantar fascia stretching exercises.
Therapies:
Physiotherapy - A physiotherapist will teach the strengthening and stretching exercises to stabilize the ankle and heel.
Extracorporeal shock wave therapy or ultrasonic or laser therapy.
Consulting a podiatrist (foot doctor) for treatment.
Braces and Support:
Night Splints - It is a splint that has to be worn at night while sleeping. It stretches the calf and arch of the feet and holds the plantar and Achilles tendon in an extended position.
Orthotics - It is the use of shoe inserts to distribute force evenly to the feet.
Surgery: Surgery is seldom required in this condition.
Plantar fasciotomy - Surgery is done to detach the plantar fascia from the bone present in the heel.
Tenex procedure - It is a minimally invasive procedure that removes scar tissue from the plantar fascia.
Gastrocnemius recession - It is a surgical procedure that involves lengthening the calf muscle.
What Is the Prognosis of Plantar Fasciitis?
This condition usually resolves with the treatment options that are mentioned above, so the prognosis is good. But if the condition causes complications like plantar fasciitis, then it has to be managed differently.
What Are the Ways to Prevent Plantar Fasciitis?
Some of the following lifestyle changes can prevent plantar fasciitis:
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Maintain a healthy weight.
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Keep replacing the sports shoes and wear shoes with good support.
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Wear supportive footwear even at home.
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Avoid high-impact activities.
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Do leg and foot stretches.
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Keep changing walking and running shoes.
Conclusion:
Plantar fasciitis is a very common problem involving stabbing pain in the heel of the foot. In most instances of plantar fasciitis, it improves with home remedies and physical therapy, but it might take a few months. If the pain is getting worse even after trying home remedies, consult an orthopedic doctor.
