Plantar fasciitis – Symptoms and causes

Overview Plantar fasciitis, pronounced as PLAN-tur fas-e-I-tis, is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects the heel bone to the toes i.e. plantar fascia, is involved in plantar fasciitis. Plantar fasciitis generally causes stabbing […]

Overview

Plantar fasciitis, pronounced as PLAN-tur fas-e-I-tis, is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects the heel bone to the toes i.e. plantar fascia, is involved in plantar fasciitis.

Plantar fasciitis generally causes stabbing pain that is usually occurring with the first steps in the morning. As we get up and move the pain normally reduces, but it might come back after long periods of standing or when standing up after sitting.

 

Plantar fasciitis is found more common in runners. Overweight people and those people who wear shoes with inadequate support also have an increased risk of plantar fasciitis.

 

Symptoms

A stabbing pain is typically caused by plantar fasciitis in the bottom of the foot near the heel. After awakening the pain is worst when taking the first few steps, although it can also be triggered by standing for long periods or when getting up after sitting. The pain is can be worse not during the exercise but after it

Causes

The plantar fascia has the shape of a bowstring, supporting the arch of the foot and absorbing shock while walking. If tension and stress becomes too much on this bowstring, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia, although the cause of having plantar fasciitis still remains unclear in many cases

Risk factors

Plantar fasciitis can be developed without an obvious cause but some factors can increase the risk of having this condition. The factors include:

  • Plantar fasciitis is found mostly between the ages of 40 and 60.
  • Certain types of exercises or activities that are placing a lot of stress on the heel and attached tissue  such as long-distance running, ballet dancing and aerobic dance. These can contribute to the onset of plantar fasciitis.
  • Foot mechanics such as flat feet, a high arch or even a pattern of walking which is abnormal can affect the way weight is distributed when standing and can put more stress on the plantar fascia.
  • Excess weight can put extra stress on the plantar fascia.
  • Occupations such as factory workers, teachers and others who are spending most of their work hours walking or standing on surfaces which are hard can damage the plantar fascia.

Complications

Ignorance of plantar fasciitis may result in chronic heel pain that may hinder the regular activities to be conducted. Changing the way of walking as a way in order to relieve plantar fasciitis pain might lead to problems of foot, knee, hip or back

Diagnosis

Medical history and physical examination are the basis for the diagnosis of plantar fasciitis. During the exam, the doctor will examine for areas of tenderness in the foot. The area where pain is located can help in determining its cause.

Imaging tests

Usually no tests are needed. An X-ray or magnetic resonance imaging (MRI) might be recommended by the doctor to make sure another problem, such as a stress fracture, is not causing the pain.

X-ray sometimes shows a piece of bone which is spurring out from the heel bone. Previously, these bone spurs were usually blamed for heel pain and were removed surgically. But many people who are having bone spurs on their heels have no heel pain.

Treatment

Most people who are having plantar fasciitis recover in several months with conventional treatment, including resting, icing the painful area and stretching.

Medications

Ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are some pain relievers which may ease the pain and inflammation caused by plantar fasciitis.

Therapies

Exercises such as stretching and strengthening or using special devices may help in relieving symptoms. They include:

  • A physiotherapist can show a range of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. To support the bottom of the foot the therapist might teach to apply athletic taping.
  • A splint might be recommended by the physical therapist or doctor to wear so that it stretches the calf and the arch of the foot while sleeping. To promote stretching this can hold the plantar fascia and Achilles tendon in a lengthened position overnight.
  • Off-the-shelf or custom-fitted arch supports (orthotics) might be prescribed by the doctor to help in the distribution of pressure to the feet more evenly.

Surgical or other procedures

If more-traditional measures aren’t working after several months, the doctor might recommend the below:

  • Temporary pain relief can be provided by injecting steroid medication into the tender area. Multiple shots aren’t suggested as they can weaken the plantar fascia and possibly cause it to rupture. Usage of ultrasound imaging, platelet-rich plasma obtained from the patient’s own blood can be injected to promote tissue healing.
  • In Extracorporeal shock wave therapy procedure, in order to stimulate the healing, sound waves are directed at the area of heel pain. This procedure is used for chronic plantar fasciitis that hasn’t responded to more-traditional treatments. Some studies show promising outcomes, but it to be consistently effective is still in process
  • Ultrasonic tissue repair is a minimally invasive technology. Ultrasound imaging is used to guide a probe which is like a needle into the damaged plantar fascia tissue. Using ultrasound energy, the probe tip vibrates rapidly to assist in breaking up the tissue which is damaged, which is then suctioned out.
  • Surgery is needed for few cases to detach the plantar fascia from the heel bone. This option is only used when the pain is severe and other treatments have failed. It can be conducted as an open procedure or through a small incision giving local anesthesia.

Lifestyle and home remedies

To decrease the pain of plantar fasciitis, these self-care tips should be tried:

  • Try to maintain a healthy weight because carrying extra weight can put extra stress on the plantar fascia.
  • Buy shoes with a low to moderate heel should be bought, thick soles, good arch support and extra cushioning. Avoid walking barefoot.
  • Old athletic shoes should be replaced before they stop supporting and cushioning the feet.
  • Try a low-impact sport should be tried, such as swimming or bicycling, instead of walking or jogging.
  • Cloth-covered ice-pack to be kept over the area of pain for 15 minutes three or four times a day. Icing can help to decrease pain and inflammation.
  • Plantar fascia, Achilles tendon and calf muscles can be stretched with simple home exercises

Preparation for appointment

The family physician may be consulted initially then the physician may refer to a specialized doctor in foot disorders or sports medicine.

 

A list might need to be written that includes:

  • Symptoms and when they started
  • Information regarding family’s medical history and activities done that could have contributed to the symptoms
  • Medications, vitamins or other supplements being taken, including doses
  • Any questions to be asked to the doctor

Don’t hesitate to ask questions.

Your doctor is likely to ask questions, which may include:

  • Symptoms tending to occur at a particular time of day?
  • Types of shoes usually worn?
  • Runner or participation in any sports that involve running?
  • A physically demanding job?
  • Previous problems with the feet?
  • Feeling pain anywhere besides the feet?
  • If anything seems to improve symptoms?
  • If anything appears to worsen the symptoms?

 

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