Plantar fasciitis is a very common condition that affects the foot and is the reason for most orthopaedic complaints. The condition can e described as the thickening or inflammation of the plantar fascia ligament which stretches across the sole of the foot (from the heel to the toes).
As the majority of people walk across their lifetime, the foot region experiences general wear and tear and the plantar fascia acts as a cushion supporting the arch of the foot. When the foot experiences too much pressure, the plantar fascia can become damaged and inflamed causing pain and stiffness.
This condition is usually characterised by a mild, gradual pain at the bottom of the foot usually near the heel (which can sometimes be misdiagnosed as a heel spur) and might then radiate through to the centre of the foot sole. The pain is usually most prominent during the morning as the plantar fascia has been relaxed during the night, but is then suddenly utilised again when getting up. As the plantar fascia stretches out and warms up the pain then usually lessens.
The main symptoms are identified as:
- Slight or severe pain when pressure is applied to the sole of the feet
- “First step pain” which usually occurs in the morning when waking
- Pain when standing after long periods of idleness
Causes and Risk Factors
Plantar fasciitis usually occurs as a result of repetitive over-extension of the plantar fascia. It can therefore be referred to as a overuse injury. Although traditionally it is thought that the condition causes inflammation, it has been found that due to the absences of inflammatory cells present in the fascia, the condition occurs most likely due to degeneration or tearing of the plantar fascia.
Although the condition is mostly common in active sport individuals or those who participate in frequent activities such as running or dancing, it can occur in the average human being. There are also certain factors that can increase the likelihood of this condition such as:
- Being overweight – this means increased load on the foot which is likely to lead to pain
- Flat foot or over pronation – the tissue of the plantar fascia is strained as it is stretched more than due to the flat foot
- Tight ankle tendons – such imbalances can pre-dispose individuals to also suffer the same with the plantar fascia
- Wearing inappropriate of uncomfortable footwear – wearing shoes that do not support the arch of the foot or that have thin soles are not ideal
- High arched feet – can cause a strain at the fascia attachment due to the rigidity and lack of support
- High intensity sport – involvement in sports that requirement repetitive foot movement at high impact
Although men can develop plantar fasciitis, it is said to be more prominent in women. You are also more likely to develop it as you become older.
The diagnosis of this condition is usually carried out by a doctor or an orthopaedic specialist. An initial assessment will help in discovering the individual’s general health and any previous and current injuries that may have been sustained to the area. These questions are asked in order to ascertain the exact pressure points and location of pain in the foot. After confirming this, the doctor will then perform certain tests to confirm their judgement and diagnose the injury, these test include:
- Range of motion – this is carried out in order for doctor to know how limited the motion of the foot from the ankle is and at which point the pain begins or stops. Particular focus is placed on the dorsiflexon (pointing the toes upwards), as failure to be able to do so may indicate tightness around the calf muscles and heel.
- Posture – the doctor is likely to study how the individual stands and walks, loking in particular to the arch of the foot especially as flat feet (overpronation), oversupination or a high arch can contribute to plantar fasciitis
- Pain and inflammation – a closer inspection of the sole of the feet is carried out, and is felt (palpated) to confirm where the pain epicentre is and possibly any soreness of the area.
Treatment for this condition normally involves the combination of various pain relief methods, light stretching and reconditioning of the plantar fascia until full healing is achieved. Combining these effectively is usually the best approach in treating plantar fasciitis.
In order to reduce any pain and prevent further degradation or inflammation, it is recommended to adopt the R.I.C.E (Rest, ice, compress, elevate) principle as with most injuries involving the muscles or tissues. Ice should be wrapped in a towel or cloth and applied to the area causing pain for between 10-15mins every few hours. Cold packs and hot packs can also provide a similar benefit.
Pain killers – over the counter treatments and NSAIDs (anti-inflammatory medication) are useful in decreasing pain and inflammation.
Stretching – light stretching of the foot and heel a few times a day can be done to ensure the tissue becomes flexible and not stiff after injury
Orthopaedic footwear – gaits and heel pads have been known to help reduce the chance of plantar fasciitis reoccurring as they cushion the heel preventing pain whilst on your feet for a long period
Splint – a night splint is often used to prevent the plantar fascia for shortening during the night as it id kept in place at a certain angle
More direct medical treatments for plantar fasciitis include
- Ultrasound therapy – gentle sound waves are emitted on the area to reduce inflammation
- Shockwave therapy – normally used if there Is consistent pain for over 4-6months, wherein a high intensity wave is released to aid healing of the area.
- Steroidal injections – an anti-inflammatory injection is applied directly to the site of the pain which may temporarily provide relief around the heel and sole. This method though should be limited in its use.
There are certain steps that can be taken to reduce the risk of plantar fasciitis, these include:
- Wearing the correct footwear – ensuring that your footwear is not too old with a worn out sole is important. Shoes with adequate cushioning are better at protecting the plantar fascia
- Protective covering – taping the foot adequately can help the recovery process and support it after an injury
- Stretching – flexing and rotating the muscles in the lower leg can help in conditioning the plantar fascia properly
- Gradual training – when returning from injury, a measured training approach is essential in order to prevent a reoccurrence of the injury
- Apply ice – icing the foot after training can help to reduce any sudden inflammation and lower overall pain