What Is Plantar Fasciitis

Plantar Fascia

Overview

Plantar fasciitis is a painful condition causing heel pain and many people with the condition also have heel spurs. It affects the band of tissue (plantar fascia) that supports the middle part of the foot and runs along the sole of the foot from the heel to the ball of the foot. Usually the plantar fascia is strong and flexible but due to certain factors it can become irritated and inflamed where the plantar fascia joins the bone in the foot. Heel spurs occur when there's constant pulling of the fascia at the heel bone. This leads to a bony growth or spur. The symptoms of plantar fasciitis are pain in the arch of the foot or heel. This pain is usually worse in the morning after rest when the plantar fascia tightens and shortens. Heel spurs cause a stabbing pain at the bottom or front of the heel bone.




Causes

Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, the presence of a leg length inequality, and flat feet. The tendency of flat feet to excessively roll inward during walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with plantar fasciitis and is an independent risk factor. Studies have suggested a strong association exists between an increased body mass index and the development of plantar fasciitis. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors.




Symptoms

Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.




Diagnosis

Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.




Non Surgical Treatment

Treatment of heel pain caused by plantar fasciitis begins with simple steps. There are a number of options for treatment of plantar fasciitis, and almost always some focused effort with nonsurgical treatments can provide excellent relief. In rare circumstances, simple steps are not adequate at providing relief, and more invasive treatments may be recommended. Typically, patients progress from simple steps, and gradually more invasive treatments, and only rarely is surgery required.

Plantar Fasciitis




Surgical Treatment

When more-conservative measures aren't working, your doctor might recommend steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

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