Plantar fasciitis, also known as fashee-EYE-tiss, is responsible for causing pain on the bottom of the heel and is considered one of the most prevalent causes. Around 2 million individuals seek treatment for this condition annually.
When the plantar fascia, a robust tissue band that helps the arch of your foot, becomes irritated and inflamed, plantar fasciitis develops.
Anatomy
Step by step, without adding or removing information, rephrase the given text while maintaining the same meaning: 1. The plantar fascia, which is located directly beneath the skin on the bottom of your foot, is a long and thin ligament. 2. This ligament connects the front of your foot to the heel, supporting the arch of your foot.
Cause
Plantar fasciitis occurs when excessive pressure causes damage or tears to the plantar fascia, which is responsible for absorbing the impact of walking, running, and engaging in sports. Inflammation is the body’s natural reaction to injury, leading to heel pain and stiffness in the case of plantar fasciitis.
Risk Factors
In the majority of cases, plantar fasciitis occurs without a particular, identifiable cause. Nevertheless, several factors can increase your susceptibility to the condition:
- New or increased activity
- Repetitive high impact activity (running/dancing/sports)
- Prolonged standing on hard surfaces (especially among nurses, factory workers, and teachers)
- Anatomy (flat feet or a high arch)
- Tight calf muscles
- Obesity
- Age (plantar fasciitis is most common among people aged 40 to 60)
Symptoms
The symptoms most frequently seen in plantar fasciitis are:
- Pain on the bottom of the foot near the heel.
- Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain goes away after a few minutes of walking
- Greater pain after (not during) exercise or activity.
Doctor Examination
Once you have described your symptoms and discussed your concerns, the doctor will proceed to examine your foot, specifically searching for these indicators:
- A high arch or flat foot
- An area of maximum tenderness on the bottom of your foot, just in front of your heel bone
- Limited dorsiflexion, or “up” motion, in your ankle
- The absence of symptoms from other conditions, such as insertional Achilles tendinitis, calcaneal (heel) stress fracture, or plantar nerve entrapment
Tests
In order to ascertain that your heel pain is due to plantar fasciitis and not another issue, your doctor might request imaging tests.
X-rays
X-rays are beneficial for ruling out fractures or arthritis as they offer clear images of bones, thereby assisting in determining other causes of heel pain.
X-rays can reveal the presence of heel spurs. Long-lasting tension on the spot where the plantar fascia attaches to the heel bone can lead to the development of a heel spur. Despite this, the majority of individuals with heel spurs do not experience heel pain. Thus, it is possible to treat plantar fasciitis pain without the need to remove the heel bone spur, as it is not the underlying cause.
Other Imaging Tests
Imaging tests like MRI and ultrasound, although rarely ordered, are not commonly used for diagnosing plantar fasciitis.
If the initial treatment methods do not provide relief for the heel pain or if your doctor suspects that another issue is causing the heel pain, an MRI scan may be recommended.
Non-medical Treatments
The first treatments for plantar fasciitis do not consist of injections or surgery. Some treatments, like rest and stretching, can be initiated by patients independently, while others should be performed with guidance from a doctor.
Patients are recommended to reduce their engagement in jogging or prolonged activities that require them to be on their feet. Typically, this reduction in activity only needs to be maintained for a week or two in order for the plantar fascia to heal.
Wearing better footwear, such as shoes with soft soles and arch supports, can reduce strain on the plantar fascia, leading to less pain. In certain cases, athletes can experience significant relief from plantar fascia pain simply by switching their running shoes.
A variety of taping techniques can be utilized by a physical therapist to provide support to the plantar fascia and allow it an opportunity to recover.
Shoe inserts, such as orthotics, can be placed in certain shoes to provide support and reduce strain on the plantar fascia. Another option available is a heel cup, which is specifically designed to support and cushion the heel.
Stretching can help alleviate the stress on the plantar fascia by increasing flexibility in the ankle, Achilles tendon, and calf muscles, which are all associated with plantar fasciitis.
Stretches that are commonly recommended include:
- Sit in a chair and with feet flat on the ground, then place a tennis ball under the affected foot. Using gentle pressure, roll the tennis ball back and forth under the foot.
- Stand 18 inches away from a wall with feet about 6 inches apart and place hands against the wall, at shoulder height. Without moving feet, lean into the wall, flexing the foot and stretching the Achilles tendon and calf muscles
- Sit on the floor with legs straight in front. Wrap a belt or exercise strap around the ball of the foot, and gently pull on the strap, forcing the foot to flex.
Dorsiflexion stretches are stretches in which the top of the foot and toes move towards the shin, like the last two stretches.
There are a couple of methods that can be used to find relief from plantar fasciitis pain. One of these methods involves applying a cold-pack or bag of ice to the bottom of the foot. Another way to find relief is by rolling the bottom of the foot on a frozen plastic water bottle.
Increasing the number of steps per mile by using shorter strides but maintaining the same speed can reduce stress on the plantar fascia for runners, despite having a higher cadence with more steps per minute.
In the process of losing weight, the additional strain placed on the plantar fascia tissue due to extra weight will be reduced. This will result in a decreased burden on the body’s musculoskeletal system, including the plantar fascia.
Night splints are plastic casts that are worn at night to keep the ankle flexed at 90 degrees, preventing the plantar fascia from resting in a contracted position. It is understandable that many people find these splints difficult to sleep in.
Although deep myofascial massage is not typically recognized as a conventional therapy, it may enhance blood circulation and aid in the healing process.
Although there is some disagreement among experts, it is believed by some that using manual manipulation or mobilization, performed by a chiropractor or other qualified health professional, in conjunction with exercise, can be an effective treatment option for plantar fasciitis.
In addition to medications, injections, or surgical treatments, individuals suffering from persistent cases of plantar fasciitis ranging from moderate to severe may utilize these non-medical treatments simultaneously.
Medications
Medications can provide relief from pain and reduce inflammation caused by plantar fasciitis. However, it’s important to note that medications alone cannot cure plantar fasciitis, so they should be combined with other treatment methods.
NSAIDs, which stands for non-steroidal anti-inflammatory drugs, are utilized for the purpose of diminishing swelling and inflammation. They are advised for individuals encountering moderate to severe pain. Examples of NSAIDs include popular brands like Bayer (aspirin), Advil (ibuprofen), Aleve (naproxen), and cox-2 inhibitors.
Patients who cannot tolerate injections or who wish to avoid them may be recommended iontophoresis as a treatment for plantar fasciitis. This treatment involves using a gentle electric current to deliver anti-inflammatory medication, such as dexamethasone, to the affected area through healthy skin.
If patients do not experience relief from plantar fasciitis with non-medical treatments and medications, they may contemplate using injections.
