Plantar fasciitis

an unbearable foot disease!

Introduction

Plantar fasciitis is the most common nerve entrapment syndrome experienced by millions of people across the world. Plantar fasciitis is a chronic heel pain, with a stiffness which is hard to bear in the mornings. Mostly it is felt after a period of rest. People with flat feet are more prone to have the condition. Plantar fasciitis is also termed as heel spur syndrome. Heel pain may also develop due to other conditions like tendonitis, stress fracture, arthritis, nerve irritation, or sometimes due to a cyst.

Heels subjected to maximum wear and tear

What happens to your foot in planter fasciitis?

Plantar fasciitis happens due to the inflammation in the plantar fascia ligament. This fascia is made of numerous bands of tissues, which are positioned at the base of your foot. These tissues run through the heel bone to the toes. When you walk, it makes these tissues stretch. So, plantar fasciitis or inflammation occurs when these tissues get torn.

What are the symptoms of planter fasciitis?

Heel anatomy and inflamed plantar fascia

The most common symptom of plantar fasciitis is aching pain, which is burning or stabbing in nature, occurs on the bottom of the heel. The pain is severe in the morning time because the ligaments tighten up while we sleep. When we stand and take the first step, it puts pressure on the ligament, which makes the pain more severe. Resting your foot usually reduces the pain.

Some mild exercise can help you to get rid of the discomfort and pain, but it can return after a long walk or standing for a long time. The pain may also aggravate in sudden stretching of the foot like climbing stairs. Some people may develop the condition in both the feet simultaneously.

Most of the patients with plantar fasciitis, will not require surgery or any invasive procedures to stop pain and reverse damage. The treatments which are less invasive can help fix the problem.

What are the trigger factors of Planter Fasciitis?

Heel spur syndrome or plantar fasciitis occurs due to the damage or inflammation of the plantar fascia. Some of the risk factors which can trigger the condition are:

  • If you have recently started exercising in a different area for, e.g., running on the road instead of a track.
  • If you've been wearing shoes with imperfect cushioning or poor arch support.
  • If you are overweight - this puts extra strain on the heel.
  • If there is overuse of your sole.
  • If you have a tight Achilles tendon (the large tendon at the bottom of the calf muscles which runs above your heel). It can affect your ability to bend the ankle and make it more prone to damage your plantar fascia.
  • Overuse of your sole.
  • Arthritis is one of the common trigger factors which usually occurs in the elderly people.
  • Often there is no obvious cause found of the condition, especially in the elderly patients. A common misconception among the general people is that the heel pain occurs due to the growth of heel bone (calcaneus). Some people may have a bone spur on the heel bone, but it does not happen in all the patients with plantar fasciitis.

    Is Planter fasciitis common?

    About 1 in 10 people have the problem at some point in their lives. Plantar fasciitis is a very common orthopedic condition, occurs between the ages of 40-60 years. However, it can occur at any age. Women and athletic people are prone to have the condition.

    How can Planter Fasciitis be diagnosed?

    X-ray of heel showing thickened plantar fascia

    The condition can be diagnosed just by examining the feet. However, some tests are also advised to rule out the other suspected causes of the heel pain. Some of these are:

  • X-rays or ultrasound of the heel fascia.
  • Ultrasound usually shows thickening and inflammation of the fascia in plantar fasciitis.
  • What are the treatments available for plantar fasciitis?

    Usually, the pain gets subsided over time. The tissue 'fascia', is just like the tissue 'wave', which gets cured very slowly. It can even take several months to go. However, the below mentioned conservative treatments can help get speed recovery.

    Pain Relief

  • Analgesics, such as acetaminophen work really great to relieve pain often. Sometimes anti-inflammatory drugs like ibuprofen are also very helpful. These are the painkillers but also reduce the inflammation that work better than ordinary painkillers. Rubbing a cream or gel, containing an anti-inflammatory medication on the heel, can also give you relief from pain.
  • Holding an ice bag on the area using a thin cotton cloth for 15-20 minutes may also help relieve pain.
  • Foot Rest

    This should be done as much as possible. Avoid running, too much walking or standing, and undue stretching of the sole.

    Footwear

    Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support. Wearing a pair of comfortable sports shoe instead of an open sandal is probably the best option. Avoid old or worn shoes which cannot give a good cushioning support for the heel.

    Heel and arch support

    You can buy pads and insoles to cushion the heel and support the arch of your foot. These work best if you put it on your shoes at all the times.

    Steroid injections

    A steroid (cortisone) injection is sometimes recommended by the doctors if the pain remains even after trying the other conservative means. A steroid injection can give relief for several weeks. It works by reducing the inflammation. Some patients require 2 or 3 injections if the first or second one do not work.

    What are the Physiotherapy regimens available for Planter Fasciitis?

    Heel pain and physiotherapy management

    Physiotherapy treatment options are like:

  • Stretching the calf / hamstring
  • Soft tissue massage
  • Foam roller to the affected muscles
  • Electrotherapy (ultrasound treatment)
  • Exercises to improve balance, strength, lower limb control or gait training
  • Tips activity modification
  • Biomechanical correction (braces)
  • Footwear assessment
  • The development of a return to activity / program running
  • What are the measures to prevent Planter Fasciitis?

    There are certain things you can do to prevent the condition, especially if you already experienced it once in the past. Some of these are:

  • Changing your shoes regularly used for jogging or walking.
  • Wearing shoes with good cushioning effect in the heel shoes and a good arch support.
  • Losing weight if you are obese/overweight.
  • Regular stretching exercise of the plantar fascia and Achilles' tendon, mostly before exercise.
  • Avoid exercising on hard surfaces.
  • So, if you are experiencing pain in your heel when you wake up in the morning, then we strongly suggest you to visit your doctor to find out the actual underlying cause.