Plantar Fasciitis

Plantar fasciitis is a disorder that results in pain around the heel and the bottom of the foot. The pain is particularly severe when taking the first steps of the day or after a period of rest. The patient will also experience pain when bending the foot and toes up to the shin.

This is one of the most common causes of heel pain experienced by North American adults. Plantar fasciitis affects up to 1 in 10 people at some point in their lives.

The causes have not been fully established. However, the commonly recognized risk factors are spending prolonged periods standing, high impact exercise and being overweight.

Plantar fasciitis treatment includes rest, icing and use of night splints. It should also include physical therapy exercises to stretch the calf muscles and the plantar fascia.

In addition to reading this article, you can find more information about managing and recovering from plantar fasciitis symptoms here.

Causes

The plantar fascia is a thick bowstring-shaped band of tissue that extends across the bottom of the foot. It extends from the heel bone to the region just behind the toes (the metatarsals).

The plantar fascia supports the arch of the foot and helps to absorb shocks transmitted from the ground while walking.

Over time, the cumulative impact of tension and stress on the plantar fascia can become excessive. This can produce small tears in the tissue of the fascia. Repeated pressure on the plantar fascia can then cause the appearance of inflammation and the development of plantar fasciitis. The inflammation affects mainly the part of the fascia where it inserts into the heel bone (calcaneum).

Under this scenario, plantar fasciitis is an overuse injury caused by structural breakdown of the plantar fascia.  This structural breakdown is the result of repetitive microtrauma (small tears) to the fascia.

This scenario accounts for many of the observed cases of plantar fasciitis. However, there are some situations when it appears with no obvious cause.

Risk Factors

Risk factors for plantar fasciitis include the following:

• Participation in sports that require extensive running or other high impact activities (e.g. those requiring plenty of jumping), especially if the person is not used to this or previously had a sedentary lifestyle:
• Other activities (perhaps job related) that require standing for long periods, e.g. teaching, waiting tables at a restaurant;
• Having adult acquired flat feet (also known as fallen arches) can cause disposition to plantar fasciitis. Having high arches can also increase the risk of plantar fasciitis;
• Individuals with unusual gait patterns may have a higher risk of developing plantar fasciitis. The gait pattern of these individuals may place unusual pressure on the plantar fascia and initiate the micro tearing described above.
• Wearing shoes with poor cushioning or arch support for athletic activity, particularly high impact activity;
• Being overweight is another risk factor that can increase your risk of developing this condition. Overweight individuals place greater stress on the plantar fascia ligament over time. This is because the shocks from the ground while walking are greater. This can then lead to the breakdown of the fascia and then to plantar fasciitis;
• Having a tight Achilles tendon can make it more difficult to flex your ankle. You are then more likely to damage your plantar fascia.

Plantar Fasciitis Symptoms

The main symptom of plantar fasciitis is a stabbing pain along the bottom of the foot and near the heel. Often, the pain is initially diffuse and then later localises to the inner aspect of the heel.

People with plantar fasciitis usually report that the pain is most severe when taking the first few steps of the morning. It then decreases in severity as the day progresses.

Another characteristic of this foot pain is that it usually flares up after a period of strenuous activity, not during it.

Sometimes, the pain can get worse after standing or sitting for a while and then getting up to start moving again.

The pain is also usually aggravated by high impact exercise (i.e. activity involving running or jumping).

Complications

Over time, individuals with untreated plantar fasciitis can change the way they walk to reduce the pain they are feeling. Their new gait patterns may then lead to problems elsewhere in the feet or in the hips, knees or even back. Further possible complications include chronic heel and arch pain as well as scar tissue.

Diagnosis

To diagnose plantar fasciitis, doctors will usually first review the patient’s medical history. The painful area along the bottom of the foot will then be examined to ascertain its exact location.

Imaging tests will not usually be required. A doctor will probably only request them to rule out other possible causes of the symptoms, such as a stress fracture.

Treatment

Treatments for plantar fasciitis can be either home-based or provided by a doctor. We will list the home-based conservative physician based treatments first.

Home Based

To treat your plantar fasciitis, you can follow the following steps at home:

• Rest – avoid strenuous activities that may place additional stress on your feet. Avoid walking barefoot on hard surfaces;
• Apply ice or a cold compress to the plantar fascia for 15-20 minutes at a time. Repeat 3-4 times a day;
• Daily performance of physical therapy stretching exercises designed to keep the plantar fascia and calf muscles supple and strong;
• Possible use of a night splint such as the BioSkin night splint or the Darco Body Armor Night Splint. These products will keep the plantar fascia stretched while you are asleep at night. A foot sleeve like the DCS Plantar Fasciitis Sleeve can also perform a similar role.
• Certain ankle braces (such as the BioSkin Trilok, for example, can help to relieve plantar fasciitis symptoms due to flat feet).
• For pain control, you can consider an over the counter (OTC) pain relief medication such as Tylenol. Other OTC drugs such as NSAIDs (Naproxen or Ibuprofen) will provide pain relief. They will also help to treat the inflammation of the plantar fascia.
• If you have flat feet, consider using shoe inserts like heel pads and arch supports. They will provide additional support for the arch of your foot. You can either have these inserts custom made by a podiatrist or you can purchase cheaper ones over the counter.

Treatment By A Doctor

If the above home-based treatments fail to provide relief from plantar fasciitis symptoms, consult with a doctor for medical advice. Physician based treatments can be either conservative or surgical.

Non or Minimally Invasive Physician Treatment

Steroid Injections

A doctor may suggest injecting  a steroid medication into the painful and tender area to combat inflammation. However, this is a risky procedure as it can weaken the plantar fascia and cause it to rupture. There is also a small risk of infection.

Shock Wave Therapy

This procedure directs sound waves at the painful area of the heel in an attempt to stimulate the healing process. However, this approach has so far shown no consistent pattern of success.

Ultrasonic Energy

This procedure uses ultrasound imaging to insert a needle-like probe into the damaged tissue. It then uses ultrasound energy to vibrate the probe rapidly in an attempt to break up the damaged tissue. Once this is done, doctors will then suction the damaged tissue out of the plantar fascia.

Surgical Treatments

Traditionally, heel spurs  were thought to be a cause of plantar fasciitis pain. As a result, they were removed surgically as part of the treatment. However, the link between heel spurs and plantar fasciitis is not clear. The spurs can exist in many patients with no heel pain being present.

The more standard surgical treatment for plantar fasciitis is to detach the plantar fascia from the heel bone. This is usually a last resort option. Doctors will generally only opt for it when the patient is in severe pain. In addition, there must have been no improvement with conservative treatments after 12 months.

Surgery is not always successful. It is also associated with the risk of complications such as infection, increased pain or injury to nearby nerves.

Prevention

To avoid this unpleasant condition, the following steps can be taken:

• Try to reduce your amount of high impact physical activity such as running or walking. If you play a sport that involves plenty of jumping, you should try to reduce your involvement in it as well.  If you want to maintain the same activity level, consider switching to lower impact aerobic activities such as swimming or cycling.
• Weight reduction can be an effective prevention step for overweight individuals;
• Make sure to use shoes with good arch support when engaging in high impact athletic activity. Avoid old shoes or those with worn out arch supports;
• Cross train by mixing high and low impact activities;
• Doing stretching exercises for the plantar fascia and Achilles tendon, especially before exercise;
• Avoiding exercising on hard surfaces as much as possible.