What Is Plantar Fasciitis? Causes and Treatment
Medically Reviewed By : Dr Sravya, MBBS, MS
Introduction
Plantar fasciitis is the most frequent kind of plantar fascia injury, accounting for 80% of all occurrences of heel discomfort. Women, military recruits, elderly athletes, dancers, people with obesity, and young male athletes are more likely to develop the illness.
Plantar fasciitis is thought to afflict one in every ten people at some point in their lives, with people between the ages of 40 and 60 being the most typically affected.
What Precisely Is Plantar Fasciitis?
Plantar fasciitis, also known as plantar heel pain, is a condition affecting the plantar fascia, which is the connective tissue that supports the arch of the foot. It causes discomfort in the heel and bottom of the foot, which is generally worse with the first steps of the day or after a period of rest.
- Pain can also be caused by bending the foot and toes up towards the shin. In around one-third of instances, the pain develops gradually and affects both feet.
- The exact etiology of plantar fasciitis is unknown. Risk factors include overuse, such as prolonged standing, increased physical activity, and obesity. It is also linked to inward foot rolling, a tight Achilles tendon, and a sedentary lifestyle. It is unknown whether heel spurs play a role in the development of plantar fasciitis, even though they are regularly found in patients with the disease.
- Plantar fasciitis is a condition characterized by microrips, collagen breakdown, and scarring at the insertion point of the ligament on the bone. Because inflammation has little or no function, a review advocated renaming it plantar fasciosis. The presentation of symptoms is mainly used to make a diagnosis, with ultrasonography sometimes being used. Osteoarthritis, ankylosing spondylitis, heel pad syndrome, and reactive arthritis are all illnesses with comparable symptoms.
- The majority of plantar fasciitis patients resolve with time and conservative treatment techniques. Those affected are frequently recommended to rest, adjust their activities, take pain medicines, and stretch during the first several weeks. If this is not enough, physiotherapy, orthotics, splinting, or steroid injections may be considered. If these procedures are ineffective, other measures, such as extracorporeal shockwave therapy or surgery, may be considered.
Anatomy Of Plantar Fascia
- The plantar fascia, also known as the plantar aponeurosis, is a strong connective tissue aponeurosis that supports the arch of the foot on the bottom (plantar side). It extends from the calcaneus tuberosity (heel bone) to the heads of the metatarsal bones (the bone between each toe and the bones of the midfoot).
- The plantar fascia is the thick central tissue that surrounds the plantar muscles. It runs from the medial process of the tuber calcanei to the proximal phalanges of the toes. It offers some connection to the toe flexor muscles.
- The plantar fascia becomes continuous distally, with a fibrous sheath encircling the flexor tendons as they progress to the toes. The plantar aponeurosis creates the superficial transverse metatarsal ligament at the anterior extremity of the sole, inferior to the metatarsal heads.
Structure
- The plantar fascia is mostly composed of longitudinally oriented collagen fibers. The medial component, the central component (plantar aponeurosis), and the lateral component are different structural components. The largest and most visible component is the center component.
Functions
- The influence of toe dorsiflexion on arch height The mechanism of the windlass
- The plantar fascia supports the arch of the foot by serving as a tie-rod, undergoing tension as the foot bears weight.
What Are The Causes Of Plantar Fasciitis?
Causes
- The plantar fascia is intended to absorb the significant stresses and strains placed on our feet when walking, jogging, and engaging in other activities such as sports. However, excessive pressure might cause tissue injury or tear.
- Plantar fasciitis is caused by the body's natural reaction to damage, which causes heel pain and stiffness.
Risk factors
In the majority of instances, plantar fasciitis develops without apparent cause. However, other circumstances might make you more susceptible to the condition:
- Increased or new activity
- High-impact repetitive activity (running, dancing, or sports)
- Standing for lengthy periods on hard surfaces (particularly among nurses, industry employees, and teachers)
- Flat feet or a high arch of feet.
- Limb-leg discrepancy( inequality)
- Calf muscles (Achilles tendon) that are too tight
- Obesity
- Age (those aged 40 to 60 are more likely to suffer from plantar fasciitis).
- Inappropriate footwear
- Diabetes
- Arthritis
What Are The Signs And Symptoms Of Plantar Fasciitis?
- Pain around the heel on the bottom of the foot.
- Pain after getting out of bed in the morning or after a lengthy period of relaxation, such as after a long vehicle trip After a few minutes of walking, the ache subsides.
- Pain is worse after (not during) exercise or activity.
- Numbness, tingling, swelling, or radiating pain
- When the plantar fascia is overworked in the context of plantar fasciitis, it can rupture. A clicking or cracking sound, substantial local swelling, and intense pain in the bottom of the foot are typical indications and symptoms of plantar fascia rupture.
How Can We Diagnose Plantar Fasciitis?
1. Physical examination:
- A healthcare professional would typically diagnose plantar fasciitis after taking into account a person's presenting history, risk factors, and clinical examination.
- During the physical examination, palpation along the inner side of the heel bone on the sole may reveal soreness. The foot may have reduced dorsiflexion due to calf muscle or Achilles tendon stiffness. Foot dorsiflexion may cause discomfort due to straining of the plantar fascia during this action.
2. Diagnostic imagination:
- X-rays produce detailed pictures of bones. They help to rule out other possible reasons for heel discomfort, such as fractures or arthritis.
- An X-ray can reveal heel spurs. A heel spur can be caused by long-term strain on the plantar fascia insertion (the area on the heel bone where the plantar fascia attaches). However, the majority of people with bone spurs on their heels do not have heel discomfort. Plantar fasciitis discomfort can be addressed without removing the spur because heel bone spurs are not the source of the condition.
- If early treatment techniques do not improve your heel pain or if your doctor is worried that a separate condition is causing your heel pain, an MRI scan may be utilized.
3. Diagnostic tests:
- C-reactive protein, erythrocyte sedimentation rate, antinuclear antibodies, rheumatoid factor, HLA-B27, uric acid, or Lyme disease antibodies may also be acquired as diagnostic tests.
- Neurological impairments may necessitate an electromyography examination to rule out nerve or muscle injury.
What Treatments Are Available For Plantar Fasciitis?
Non-surgical approach
More than 90% of plantar fasciitis sufferers will improve within 10 months after beginning easy treatment approaches.
The first stage in pain reduction is to reduce or altogether eliminate activities that aggravate the pain. You may need to discontinue sports activities that require your feet to pound on hard surfaces (such as jogging, dancing, or step aerobics). Your doctor may advise you to use a walking boot and crutches for a brief amount of time to rest your foot.
Cycling or swimming, for example, exerts less strain on your joints and feet than walking or jogging.
Tight muscles in your feet and calves cause plantar fasciitis. The most effective technique to ease the discomfort associated with this issue is to stretch your calves and plantar fascia.
Stretching the calves
- Lean against a wall with one knee straight and a heel on the ground. Place the other leg in front of you, knee bent. Push your hips towards the wall in a methodical manner to stretch the calf muscles and heel cord.
- Relax after holding the posture for 10 seconds. This exercise should be done 20 times for each foot. During the stretch, you should feel a powerful pull in your calf.
Plantar fascia stretching
- This stretch is performed while sitting. Cross your afflicted foot over your other leg's knee. Grasp your hurting foot's toes and slowly draw them towards you in a controlled manner. Wrap a towel over your big toe to help bring your toes towards you if reaching your foot is tough. With your other hand, run it along the plantar fascia.
- When stretched, the fascia should feel like a tight band along the bottom of your foot. Maintain the stretch for 10 seconds. A rep for each foot 20 times. This exercise is best performed first thing in the morning, before standing or walking.
- It is useful to roll your foot over a cold water bottle or ice for 20 minutes. This can be done three to four times each day.
NSAIDs are nonsteroidal anti-inflammatory medicines. Pain and inflammation are reduced by medications such as ibuprofen and naproxen. Use of the medicine for more than one month should be discussed with your healthcare provider.
Your doctor may advise you to engage with a physical therapist on a stretching program for your calf muscles and plantar fascia. A physical therapy program may include specialized ice treatments, massage, and other therapies in addition to the exercises listed above to reduce inflammation around the plantar fascia.
Pain while walking and standing is alleviated by wearing shoes with thick soles and additional padding. When you step and your heel hits the ground, you put a lot of strain on your fascia, which causes microtrauma (small rips in the tissue).
- A cushioned shoe or insert relieves this stress and the microtrauma caused by each stride. Soft silicone heel pads are cheap and function by elevating and cushioning your heel. Prefabricated or bespoke orthotics (shoe inserts) are also beneficial. Soft heel cushions can offer additional support.
- Avoid shoes that do not provide support or have worn out. Replace your old sporting shoes before they no longer support your feet.
The majority of individuals sleep with their feet pointed down. This relaxes the plantar fascia and contributes to morning heel discomfort. While you sleep, a night splint stretches the plantar fascia. A night splint can ease plantar fasciitis-related heel pain, though it takes some getting used to.
Wearing a cast for a short time can be very beneficial in the treatment of plantar fasciitis because it restricts your foot from moving, which promotes recovery. Because a cast is custom-molded to your foot and cannot be removed, it is frequently preferable to wearing a boot.
- Cortisone, a steroid, is an effective anti-inflammatory drug. It can be injected into the plantar fascia to relieve pain and inflammation.
- Because steroid injections might weaken the plantar fascia and produce a rupture (tear), flattening of the foot, and chronic discomfort, your doctor may limit or avoid this treatment.
Because steroid injections might weaken the plantar fascia and produce a rupture (tear), flattening of the foot, and chronic discomfort, your doctor may limit or avoid this treatment.
- ESWT stands for extracorporeal shockwave treatment. High-energy shockwave impulses boost the healing process in injured plantar fascia tissue during this technique. ESWT has not produced consistent results and is hence rarely used.
- ESWT is noninvasive, which means it does not necessitate a surgical incision. ESWT is sometimes used before surgery because of the limited (low) risk associated with it.
This is a less-invasive therapy option for those with chronic plantar fasciitis. A probe is guided toward the damaged plantar fascia using ultrasound imaging. The probe’s tip then vibrates, breaking up and removing injured tissue.
Surgical approach
Because nonsurgical treatment helps more than 90% of individuals with plantar fasciitis, surgery is usually reserved for those who have not improved following 12 months of vigorous nonsurgical treatment.
The calf (gastrocnemius) muscles are surgically lengthened. Because tight calf muscles put additional strain on the plantar fascia, this technique is beneficial for individuals who, after substantial calf stretching, nevertheless have difficulties extending their feet.
- One of the two calf muscles, the gastrocnemius, is stretched to increase ankle motion in gastrocnemius recession. The surgery can be done using a standard open incision or through a smaller incision and an endoscope, which is a tiny camera-equipped piece of equipment. Your doctor will go through the situation with you.
- Complications from gastrocnemius recession are uncommon; however, they might include sural nerve injury and calf weakness.
A partial plantar fascia release, which is frequently done in conjunction with a gastrocnemius recession, entails creating an incision on the bottom or side of the heel. The surgeon locates the plantar fascia insertion at the heel (the point at which the ligament joins the bone) and makes a partial incision to reduce tissue tension. It is also possible to remove a big bone spur.
Summary:
Plantar fasciitis, also known as plantar heel pain, is a condition affecting the plantar fascia, the connective tissue supporting the foot's arch. It causes discomfort in the heel and bottom of the foot, often worsening with the first step or rest. Risk factors include overuse, obesity, inward foot rolling, a tight Achilles tendon, and a sedentary lifestyle. The condition is characterized by microrips, collagen breakdown, and scarring at the
ligament insertion point. The diagnosis is mainly based on symptoms, with ultrasonography sometimes used. Most patients resolve with time and conservative treatment techniques. If not, physiotherapy, orthotics, splinting, or steroid injections may be considered. If ineffective, extracorporeal shockwave therapy or surgery may be considered.