What is plantar fasciitis?
Plantar fascia is a flat band of tissue or ligament that connects the heel bone to the toes of feet. In the process, it supports the arch of the foot. Straining of the plantar fasciitis weakens, swells and irritates it, resulting in heel pain when a person stands or walks.
Common in middle-aged people, plantar fasciitis also occurs in young people who spend a lot of time on their feet, like runners or soldiers. It is also seen in overweight people or people who wear shoes without adequate support.
What are the causes of the disorder?
The planar fascia acts like a shock-absorbing tissue that supports the arch or the inside sole of the foot. Tension or strain can cause small tears in the fascia, and repeated stretching or tearing leads to it becoming irritated or inflamed.
The condition is more likely to occur in
- People with foot arch issues (flat feet or high arches)
- Overweight or obese persons
- Long distance runners
- People with tight Achilles tendon
- Those who wear shoes without support or soft soles
What one needs to know about symptoms or signs?
The most common sign of planar fasciitis is pain and stiffness in the bottom of the heel. The pain in the heel may be dull or sharp, and may be accompanied by ache or burn in the bottom of the foot. The pain is more intense
- In the morning
- Upon standing or sitting for long periods or climbing stairs
- After intense physical activity
Which specialist should be consulted in case of signs and symptoms?
A person with symptoms of plantar fasciitis should consult a doctor who specializes in foot disorders (podiatrist) or sports medicine.
What are the screening tests and investigations done to confirm or rule out the disorder?
To confirm diagnosis, a doctor will
- Ask questions regarding the patient’s health record, including any injuries or illnesses in past.
- Determine the location of pain and the time of the day when it hurts most.
- Assess the patient’s activity levels.
- Suggest an x-ray of the foot if a problem with the bones of the feet (stress fracture, bone spurs) is suspected. Magnetic resonance imaging (MRI) can also check if the pain is caused by another problem like a pinched nerve or stress fracture.
What treatment modalities are available for management of the disorder?
Treatment options include:
- Medications – Pain relievers can help ease pain and inflammation that accompanies plantar fasciitis.
- Therapy – Stretching and strengthening exercises can help reduce symptoms. Therapy options are:
- Physical therapy – With the help of a physical therapist, a patient is guided through a series of exercises that help stretch the plantar fascia tissue and Achilles tendon, along with strengthening of lower leg muscles that helps stabilize ankle and heel. Athletic taping may also be used to stabilize the bottom of the foot.
- Orthotics (arch supports) – Over-the-counter heel cups, cushions or custom-made arch supports help redistribute the pressure on the feet evenly.
- Night splints – The doctor or therapist may suggest a splint that stretches the calf and arch of foot while a person sleeps. This position keeps the plantar fascia and Achilles tendon in a stretched position overnight.
- Surgery and procedures – If the pain associated with plantar fasciitis cannot be controlled through medication or therapy, the doctor may recommend the following procedures:
- Surgery – Surgery detaches the plantar fascia from the heel bone, and is performed when all conservative treatment methods fail to provide relief from severe pain. However, a side effect of surgery is the weakening of the arch of the foot.
- Steroid injections – A steroid medication is injected into the area to provide temporary pain relief. However, repeating this treatment is avoided as it can weaken the plantar fascia and cause it to rupture, while also shrinking the fat pad that covers the heel bone.
- Extracorporeal shock wave therapy – Healing is stimulated by directing sound waves to the area of heel pain. This treatment is more commonly used for chronic conditions that fail to respond to traditional treatments. This technique may, however cause swelling, pain, bruises or numbness, and its reliability in providing consistent relief is under doubt.
What are the known complications in management of the disorder?
Despite treatment, pain may continue, and the patient may be required to undergo surgery as last resort.
What precautions or steps are necessary to stay healthy and happy during the treatment?
Some self-care tips can help in relieving pain:
- Maintaining healthy weight – This reduces the stress on plantar fascia.
- Wear supportive shoes – Patients must avoid high heels, and restrict it to low or moderate heels. Shoes should provide good arch support and shock absorbency against hard surfaces.
- Moderate activity – Low impact sports like cycling or swimming can be tried instead of running or brisk walking. Simple stretching exercises for the plantar fascia, Achilles tendon and calf muscles are useful.
- Ice treatment – An ice pack over the affected area for 15-20 minutes for few times a day can reduce discomfort.
What are the dietary and physical activity requirements during the course of the treatment?
A recovering patient should resume normal activities and exercise regimen gradually. Full activity can be resumed if symptoms do not reappear.
How can the disorder be prevented from happening or recurring?
Ensuring that the Achilles tendon, the ankle and calf muscles are flexible can prevent plantar fasciitis.
“Plantar Fasciitis and Bone Spurs,” Orthoinfo.aaos.org, American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/topic.cfm?topic=a00149
“Plantar fasciitis,” MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/007021.htm
“Plantar fasciitis,” MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/basics/definition/con-20025664
“Plantar fasciitis,” WebMD.com, https://www.webmd.com/a-to-z-guides/plantar-fasciitis-topic-overview