What is Plantar Fasciitis?
Plantar Fasciitis is one of the most common cause of heel pain, and is characterized by pain and degeneration on the flat band of tissue, the plantar fascia, that connect your heel bone to your toes. The plantar fascia exists to support the arch of the foot. When strained, the plantar fascia gets weak or degenerates and causes the bottom of the foot to hurt when standing or walking.
Plantar fasciitis is common in runners, as well as those who spend extended periods of time on their feet. It is also common in people who are overweight and people who wear shoes or boots without proper arch support. However, the disease may happen to anyone.
Plantar fasciitis is known to cause stabbing pains that can often come and go throughout the day depending on a person’s level of activity. The pain is usually the worst in the mornings or after sitting for a long period of time.
WHAT CAUSES PLANTAR FASCIITIS?
The exact cause of plantar fasciitis is not completely known, but is attributed to repeated tearing of the plantar fascia. Under normal conditions, the plantar fascia acts a shock absorber that supports the arch of the foot. With increased tension, small tears can develop, which can cause irritation and inflammation if as tension and tearing continue over time. Most authors feel that it’s a degenerative condition however, with no known cause.
Plantar fasciitis can be caused be certain conditions of the feet or activities that create tension or strain on the plantar fascia may include:
- Biomechanical issues like abnormal twisting or rolling of the foot, high arches or flat feet
- Repetitive activities like running or standing/walking for extended periods of time during the workday
- Increased stress on the foot due to weight problems or poorly cushioned shoes
PLANTAR FASCIITIS SYMPTOMS
In most cases, plantar fasciitis causes stabbing pains in the bottom of the foot, usually near the inside part of the heel. These symptoms can present when taking your first steps of the day or after sitting for an extended period. In addition, people suffering from plantar fasciitis may suffer from:
- Stiffness and pain after sleeping or resting, may come and go throughout the day. Sometimes activity improves the pain
- Pain when standing for extended periods
- Pain while running our during exercise; pain after a cool-down period is also common
- Pain after prolonged activity
There are many factors that can increase a person’s risk of experiencing plantar fasciitis. These risk factors include:
- Age: Plantar fasciitis is most common in people 40 to 60 years old, but can be experienced by those younger or older
- Biomechanical Issues: People who have a high arch, flat feet or walk abnormally with an inward twist of the foot or roll of the foot. Prolonged immobilization or periods of non-weight bearing in the treatment of other injuries may also incite plantar fasciitis.
- Weight: People who are overweight are at an increased risk for plantar fasciitis as increased weight increases stress and tension on the feet
- Poor Support: Wearing shoes with little or no arch support and cushioning can increase stress on the foot and arches. Those with a damaged heel fat pad from injections may also have pain.
- Working Conditions: Workers who spend a significant amount of time standing or walking during their work day are at an increased risk for plantar fasciitis as repetitive stress and activities can increase tearing of the fascia. The symptoms from a degenerative plantar fascia are also more noticeable.
- Exercise & Activity: Military members, athletes and those who spend their time doing physical activities that include running or jumping are at an increased risk due to the repetitive nature of physical activities/exercises.
In order to properly diagnose plantar fasciitis, your doctor will perform a brief exam to check for pain points and tenderness in your foot. In addition, they will ask questions about the symptoms you’re experiencing, and the activities you were doing during the time that the symptoms presented.
In most cases, the doctor will make a diagnosis based on your history of symptoms and a physical examination alone. There may be some cases where an X-ray or MRI is recommended to ensure that the pain you’re experiencing isn’t the result of a different condition. An X-ray is not required to diagnose plantar fasciitis as it will not show the ligaments clearly. However, it will demonstrate architecture of the foot clearly and will also allow your doctor to see a ‘spur’ if you have one. A MRI can very easily show the fascia.
TREATMENTS & MEDICATIONS
Treatment for plantar fasciitis has several goals including: relieving inflammation and pain in the heel, allow any microscopic tears in the plantar fascia to heal, and to improve the strength and flexibility of the foot to prevent further damage to the plantar fascia.
There are a number of different treatments to help relieve symptoms of plantar fasciitis, including:
- Physical Therapy: Physical therapy for plantar fasciitis includes a variety of exercises designed to stretch the plantar fascia, Achilles tendon and to strengthen muscles in the foot and lower leg. The goal of physical therapy is to increase strength and flexibility in the foot, ankle and heel to increase stability. Also, a good physical therapist will address any associated hip or knee dysfunction.
- Splints & Taping: In many cases, splinting and taping will be used in conjunction with physical therapy. Splints and taping are done to stretch the calf and the arch of the foot, holding the plantar fascia and tendons in a stretched position. Often times, your doctor will recommend that splints be used overnight. Taping provides support during activity.
- Orthotics: There are many types of orthotics available to treat plantar fasciitis available. Your doctor may prescribe a heel cup, orthotic insert or cushion to help support your foot and distribute pressure more evenly. Structural orthotics, like have been shown to work better than simple cushions.
When traditional methods aren’t getting results, your doctor may recommend a further medical treatments to help reduce pain and correct problems. Such treatments may include steroid injections, shock wave therapy and in rare cases surgery. Some doctors also offer newer regenerative techniques for the treatment of plantar fasciitis.
HOME TREATMENTS & REMEDIES
Your doctor will likely recommend several treatments that can be performed at home to relieve pain. These treatments may be done in combination to achieve desired results. These at home treatments can include:
- Weight loss to reduce stress on foot
- Purchasing supportive shoes to improve foot and arch support
- Increasing foot rest and limiting stressful activities to reduce stress on the foot
- Icing the foot and heel to reduce inflammation and reduce pain
- Stretching and splinting (or taping) of the foot to increase flexibility of the foot and leg muscles
- Rolling the foot over a tennis ball to provide tissue massage