The Ultimate Guide to Plantar Fasciitis

Plantar fasciitis is quite a common condition, one that is likely to affect millions of people in their lifetime. Not many people are aware of this for a fact, but one of the first signs that raise suspicion regarding this condition is the softening of the plantar fascia, which can be efficiently detected with the help of ultrasound elastography. Caught on time, plantar fasciitis can be kept under control, with the help of conservative measures (foot orthosis, night splints etc.). There are also certain measures that one can take, in order to prevent the appearance of this condition altogether.

What is plantar fasciitis?

In the simplest of terms, plantar fasciitis is a collection of symptoms determined by the inflammation of the plantar fascia. This inflammatory condition is diagnosed in patients whose plantar fascia has been subjected to prolonged stress, with inflammation resulting as a normal consequence. According to the Clinical Practice Guidelines published in the Journal of Orthopedic & Sports Physical Therapy, plantar fasciitis is considered to be one of the most common causes of heel pain.

Anatomy

The plantar fascia is a thick band of connective tissue, which begins at the level of the heel bone, runs through the arch of the foot and stops at the base of the toes (ball of the foot). Its main role is to support the arch of the foot. The plantar fascia is attached to the calcaneus bone, as the Achilles tendon; when inflammation occurs at the level of the plantar fascia, this will have an impact on the tendon as well. As it has been shown in a study published in the Journal of Orthopedic & Sports Physical Therapy, chronic plantar fasciitis has been associated with increased vascularity and thickened fascia.

Signs and symptoms

These are the most common signs and symptoms found in patients diagnosed with plantar fasciitis, many of which has been included in a scientific article published in Alternative Medicine Review:

  • Pain at the level of the heel (medial side), which is most intense with the first steps taken in the morning and after periods of prolonged sitting
  • Pain can become worse with weight-bearing activities
  • Pain can extend to the entire foot and especially at the level of the toes, preventing the patient from bearing weight on the respective foot; limping can occur as a result
  • Tightness at the level of the Achilles tendon
  • Reduced range of motion in the affected foot
  • Tenderness upon touching or using the foot
  • Stabbing sensation when trying to put the foot on the ground
  • Unilateral affectation (typically)
  • Numbness and tingling (not typical, but possible)
  • Inflammation (can lead to restricted movement)
  • Pain can radiate towards adjacent areas
  • In case of ruptured fascia, additional symptoms:
    • Specific sounds with movement (clicking, snapping etc.)
    • Severe inflammation
    • Acute pain (most commonly at the level of the foot sole)
    • Significant reduction in the overall range of motion.

Causes

These are some of the most common causes of plantar fasciitis, highlighted in the same article that was mentioned above:

  • Repetitive movements (walking, running ) that lead to micro-tears at the level of the plantar fascia (favoring inflammation)
  • Overuse of the plantar fascia (commonly seen in professional athletes)
  • Inadequate training and/or training errors
  • Walking, running or jogging on uneven surfaces (places the plantar fascia under a lot of stress)
  • Inadequate/worn out footwear
  • Prolonged/excessive weight-bearing
  • Reduced muscle strength and inadequate attenuation of force (commonly seen in older adults)
  • Excessive pronation of the foot
  • Diabetes (peripheral motor neuroatrophy)
  • Gait dysfunction/alteration
  • Dysfunctional foot structure (claw toes, high arch etc.).

 

Treatment

According to a scientific article published in the Journal of Medical Research, plantar fasciitis can be managed and/or treated in a number of ways.

  • Physical rest
  • Heat/cold therapy
  • Medication – oral/topical (anti-inflammatory)
  • Heel pads
  • Magnetic insoles
  • Night splints
  • Taping
  • Stretching
  • Physical therapy
  • Corticosteroid injections
  • Extra-corporeal shock wave therapy
  • Ultrasound (pulse therapy)
  • Platelet-rich plasma injection
  • Pulsed radiofrequency electromagnetic field therapy.

Each method has its own benefits to offer but, in general, it is recommended to opt for the non-invasive methods first. Stretching exercises should be performed in the calf and plantar region. Physical therapy is most beneficial, increasing the overall range of motion and reducing the intensity/frequency of pain, inflammation and stiffness.

Night splints are useful as well, in the sense that they can be used to stretch the plantar fascia throughout the night. In general, these are recommended for chronic cases, with symptomatology extended over six months. Foot orthoses can correct the abnormal foot pronation, reducing the stress experienced at the level of the plantar fascia. More invasive procedures, such as corticosteroid injections, shock wave therapy and surgery are reserved for severe cases.

Prevention

It is possible to prevent plantar fasciitis, by following a few simple measures.

These are several recommendations to take into consideration:

  • Wear adequate footwear, with good support for the arch of the foot.
  • Avoid walking/running on uneven surfaces, especially with bare feet.
  • Perform stretching exercises on a regular basis, in order to reduce the tension at the level of the plantar fascia.
  • Maintain a healthy weight (reduced pressure on the feet).
  • As a professional athlete, it is recommended to wear supportive shoes, especially designed for the sport you are performing.

Final word

Plantar fasciitis may be a self-limiting condition but one should not wait for it to go away on its own. It is important to recognize the symptoms of this condition and seek out adequate diagnosis. As you have seen, it is possible to manage this condition through conservative measures; the procedures that are more invasive, surgery in particular, should always be left as a last resort. Always take good care of your feet and, remember, plantar fasciitis is not the only problem that can occur in this area. You should also pay increased attention to fungal infections, especially those that extend and affect the toenails.

References:

http://www.webmd.com/a-to-z-guides/tc/plantar-fasciitis-prevention

https://en.wikipedia.org/wiki/Plantar_fasciitis

http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/dxc-20268536

https://therunningbug.com/fitness/injuries/the-ultimate-guide-to-beating-plantar-fasciitis-how-to-prevent-treat-and-recover

https://heelthatpain.com/plantar-fasciitis-statistics/