Many of us have experienced some sort of pain on our heels without even knowing what’s causing it. Some symptoms, when presented to a doctor, a podiatrist specifically, can help them identify the cause of such pain. With the right symptoms, one might be suffering from plantar fasciitis. This is a disorder of the connective tissue which supports the arch of the foot and is characterized by pain in the heel and bottom of the foot that’s usually most severe with the first steps of the day or following a period of rest. The manifested pain typically occurs gradually and can affect both feet.
Let’s take a short lesson on foot anatomy. Basically, the foot is made up of thick, fibrous web-like bands of tissues called the plantar fascia which extends from the heel to the toes. These tissues support the muscles and the arch of the foot. Overstretching these tissues through rigorous activities can cause the surface of these tissues to tear and, in turn, these can lead to inflammation and pain. The term “heel spurs” was coined by early doctors as it was believed the pain was caused by tiny bony growths. In actuality, heel spurs are not the cause but the result of pain from plantar fasciitis.
What is Plantar Fasciitis?
To reiterate, plantar fasciitis is a disorder of the connective tissue which supports the arch of the foot. The tissue extends from the heel to the toes of the foot. This condition is one of the most common complaints to orthopedics and it affects about 8% of the populace. Of these, 10% have had the disorder at some point during their life and this becomes more common with age. Being one of the most used tissues in the body, the plantar fascia will experience a lot of wear and tear. They support the arch of the foot and act as the body’s shock absorber. When subjected to a lot of pressure, these ligaments can either be damaged or torn leading to inflammation which, in turn, can cause stiffness and pain.
The Causes of Plantar Fasciitis
It would be obvious that those who are overweight or obese have a greater risk of developing this disorder. Pressure is the operational word here. Too much weight will put stress on the plantar fascia ligaments, more especially so if the weight gain is sudden. An example of this is women during their late months of pregnancy where they will experience bouts of plantar fasciitis.
Many groups are likely to develop this disorder. Consider long distance runners for one. Also, there are those with jobs that keep them on their feet for long hours like waiters and assembly line workers. An active lifestyle where hours of exercise is required but this also has some risk. Although not many studies have been made, the cases of plantar fasciitis are more common among women.
The disorder can also occur in people with structural foot problems. Those with very high foot arches or are flat-footed are high risk. So are those with tight Achilles tendons. They can also develop plantar fasciitis. Even wearing the wrong shoes can cause the disorder, especially shoes with poor arch support and soft soles.
As mentioned earlier, plantar fasciitis isn’t the result of heel spurs. A heel spur is a bony spur projecting from the back or underside of the heel that often makes walking painful. Only about 1 out of 10 people can develop heel spurs and 1 out of 20 will experience pain.
Too much pressure on the plantar fascia can cause it to become tight and this could lead to inflammation. With a further increase in pressure, the tissue becomes tenser and this could lead to tearing. Consequently, there will be more irritation and inflammation. This will likely be more experienced with people between the ages of 40 and 70 and have active lifestyles like long distance runners and athletes.
The Risk Factors for Plantar Fasciitis
Presently, there’s still no specific and identifiable reason why plantar fasciitis develops, only that the risk of having it is associated with several factors:
- Rapid weight gain or obesity. These conditions may cause damage to the plantar fascia tissue which makes it less effective in absorbing shock and this can cause heel pain. Research has shown that about 70% of plantar fasciitis patients suffer from obesity. Also at risk are those non-athletes who have a sudden increase in BMI. The same thing goes for expecting mothers, especially in the later months of their pregnancy.
- A lot of pressure placed on the heels. For those who run or walk frequently, especially for long distances or those with jobs that require them to be on their feet for hours, they may also have this disorder. Athletes, joggers, factory workers, teachers, and more can fall under this category as the pressure on their heels can result in plantar fasciitis. Studies show that too much stretching and tightening of a person’s Achilles tendon can overstrain the plantar fascia.
- Foot abnormalities. The reason why people who have overpronation have a high risk to develop plantar fasciitis is that the whole soles of the feet come in contact with the ground while standing up. Overpronation is more commonly known as flat-footed. Conversely (and similarly), those with really high arches are also at a high-risk because their condition will put excessive amounts of pressure on the ball of the foot and the heel when they are walking or standing. Increased pressure on the plantar fascia can also cause the disorder for people who have unusual walking gaits or running styles.
- Conditions like arthritis and diabetes. If diabetes can cause plantar fasciitis, this is a matter that needs further research. Although it’s known that diabetes can cause an augmented thickness of one’s Achilles tendon. Also, plantar fasciitis is a lot more common in people who have diabetes. There are also some kinds of arthritis that are associated with plantar fasciitis. Among these are ankylosing spondylitis, rheumatoid arthritis, reactive arthritis, and psoriatic arthritis.
- Wearing the wrong kinds of shoes. Any shoes that don’t have a good fit will most likely not provide ample support to the foot. That is common sense. The wrong shoes can mess up walking and this can put more pressure on the plantar fascia ligaments. Avoid worn out or old shoes as they may not be able to provide the needed protection and support for the feet. The right shoes will not just benefit the feet but many parts of the body as well. These include the feet, legs, and lower back. Wrong shoe choices can affect body health. The choice of shoes is especially relevant for people who have diabetes and circulatory problems.
Obviously, the best kinds of shoes are those that can lessen the pressure on the plantar fascia ligament. In general, the shoes should be firm and solid. Sandals and flip-flops don’t offer much support for the feet. But if they have the right insoles, they can become a good option because they can be worn pain-free.
The Common Symptoms of Plantar Fasciitis
Those who are afflicted with this condition have pain on the bottom of their feet as the most common complaint and that pain gradually develops over time. Although the disorder usually just affects one foot, it can happen to both feet as well. The experienced pain varies, from dull to sharp. Some may also experience a burning sensation on the bottom of their foot which starts from the heel and extends outward. Here are some of the most common symptoms of plantar fasciitis:
- The time when the pain felt is at its worse happens when it’s morning as one takes his first steps of the day.
- The pain can also be experienced when one has been lying down or sitting for some time. Because of the stiffness, climbing the stairs could become an ordeal.
- Prolonged physical activities can cause the pain to a flare-up because of an increase in inflammation.
- Pain brought about by the disorder is usually felt after stopping the activity and not during.
- Although one plantar fasciitis symptom is generally described as shooting pain, this disorder can also cause swelling especially on the heel area.
- The pain caused by plantar fasciitis is most intense after a rest from physical activities, then eases out during the daytime. However, the pain will certainly recur after some physical exertions or after staying on one’s feet for long periods.
The plantar fascia is a broad web-like band of connective tissue that runs from the heel to the toes. It supports the foot’s arch and is designed to absorb any strains and stresses that the foot may be subjected to. When not using the plantar fascia, it isn’t tight. Conversely, when used, it tightens. At one point in a person’s life, he may develop inflammation or a strain of the fascia into the bone of the heel. This is understandable because the foot will always be engaged and can never really rest enough to get better and start healing. Plantar fasciitis inevitably can become a chronic and repetitive condition.
How Do Doctors Diagnose Plantar Fasciitis?
Podiatrists will usually make a routine examination to determine if you have plantar fasciitis. There is a test for tenderness felt in the foot, locating the pain’s exact point, making sure that it’s not another foot issue. The person may be requested to flex his foot while the doctor will push against the plantar fascia to check if the pain will worsen as he flexes or as he points his toes. There will also be a check on swelling or redness. An evaluation of muscle strength and health of the nerves is accomplished by checking on the muscle tone, reflexes, sense of sight and touch, coordination, and balance. To make sure that there’s nothing else causing the pain in the heel, a fractured bone, an X-ray or MRI may also be required.
Various Options for Treating Plantar Fasciitis
Although reducing the inflammation caused by plantar fasciitis is an essential part of the treatment, this will not deal with the underlying injury of the plantar fascia ligament. But there are different treatment options available including:
- Home remedies. There are some simple steps one can follow to treat the condition. First of all, it’s very important for the person to stay off his feet. One can also apply a cold compress on the affected area for about 15 minutes up to 4 times daily to reduce the swelling. Also, reduce exercise time or change exercise routines and try to use arch supports which can be placed in the shoes. One can also try some stretching exercises as they may help relieve pain.
- Pain relievers. NSAIDs can often reduce ligament inflammations. If these over-the-counter medications don’t work, consult with a doctor. He may administer corticosteroid injections directly into the injured part of the plantar fascia ligament to relieve the pain. An ultrasound may be done to specifically locate the ideal place for injection. Another method is applying corticosteroids topically to the arch of the foot or the heel then applying a painless electric charge to allow the steroid to enter the skin then the muscle.
- Physical therapy. This is also an essential part in the treatment of plantar fasciitis. Through therapy, the plantar fascia along with the Achilles tendon can be stretched. Physical therapists can also help by recommending exercises that can strengthen the lower muscles of the leg. This will help stabilize one’s walking and thus reducing the pressure on his plantar fascia ligaments.
- Supports and Braces . Another treatment option which may help in stretching the arch of the foot and the calf is by using night splints. These are types of braces that will hold the foot in a position that’s flexed, thereby lengthening the plantar fascia along with the Achilles tendon all through the night. This action will prevent the occurrence of stiffness and morning pain.
To help relieve the pain through stress distribution, one can avail of arch supports for the shoes or even special orthotics. Using these will stop any further injury to his plantar fascia ligament. Or one can even order a boot cast. This will temporarily immobilize the foot reducing the pressure or strain while the person’s plantar fascia ligament heals.
- Surgery. This is the most dramatic therapy and should be done only when the pain becomes really severe. The surgeon can partially detach the plantar fascia from its heel bone attachment. This can seriously weaken the foot’s arch and its full function may be lost. Another type of surgery involves the lengthening of the foot’s arch through an operation called the gastrocnemius recession.
If still nothing works with the aforementioned treatments, the podiatrist may recommend extracorporeal shock wave therapy. A relatively new procedure, it uses sound waves to bombard your heel which will stimulate the healing process within the ligament. This method hasn’t been proven to be consistently effective in relieving symptoms. Furthermore, there can be some side effects which can include bruising, swelling, numbness, and pain.
Other Medical Treatments for Plantar Fasciitis
Aside from the ones mentioned above, there are also other types of medical treatments for plantar fasciitis. These include:
- Orthotics. It’s best to ask one’s doctor about this type of treatment. He can prescribe custom-fit or off-the-shelf arch supports that will help in distributing pressure to the feet evenly.
- Injection. A kind of steroid medicine is injected directly into the area that’s tender for fast but temporary relief from pain. Multiple steroid injections are not recommended as it can weaken the plantar fascia. Also, there’s a possibility of it rupturing. A more recent method is using a plasma that’s rich in platelets under the guidance of ultrasound to provide relief from pain with a lesser danger of tissue damage.
- Extracorporeal shock wave therapy. This is a relatively new procedure which uses sound waves that are directed at the heel area where the pain is felt. The waves are supposed to stimulate the healing. Although there are promising results with this method, it still hasn’t been proven to be effective each and every time.
- Tenex procedure. This is not a common method of treating plantar fasciitis. It’s a minimally-invasive method is used to remove scar tissues of plantar fasciitis without any surgery.
Lifestyle And Home Treatments for Plantar Fasciitis
There are also things one can do at home to improve the condition. A person can do some home treatments to lessen the pain caused by plantar fasciitis:
- Maintain a healthy weight. Being obese or overweight will add extra stress to the plantar fascia. For this, losing weight is the obvious solution.
- Select supportive shoes and, if possible, avoid high-heeled shoes. Choose a pair with moderate heels, have great arch support, and should be shock absorbent. Also, avoid moving around on barefoot especially while walking on surfaces which are hard.
- Discard athletic shoes which are already worn-out. As they get older, old shoes will give less support and cushion to the feet, making one at risk for plantar fasciitis. For runners, buy a new pair after about 500 mileage of use.
- Consider changing sports. Choose one which will allow less impact on the feet. Definitely, jogging and running are out. Swimming, bicycling, and other similar sports are more advisable.
- Apply ice on the affected area. This is a simple procedure for relief from plantar fasciitis. Hold an ice-pack covered in cloth on the affected area for about 20 minutes. Do this three to four times daily or after some physical activity. One can also try an ice massage. Simply roll a paper cup that has been filled with frozen water over the area of pain for about 7 minutes. This massage will help in reducing inflammation and pain.
- Stretch the arches. One can do some simple exercises at home. Ask the physical therapist about the best exercises to stretch the plantar fascia and the Achilles tendons.
- Rest is also highly recommended. This is perhaps the best way to reduce the pain caused by any disorder or injury. This condition is no exception. This remedy is simple. It just requires one to either lie down or sit a couple of times all throughout the day. This will take off the strain of the body’s weight on of the feet, especially the plantar fascia ligament. A person can even do this at work. Use the break times in the office sitting down. Or apply the same to workout routines. Take several minutes off in between the exercise activities. Rest is essential in the healing of the plantar fascia’s micro-injuries. Over time, one will feel the healing effects of these resting periods.
- The icing is another simple but effective remedy. Just place an ice pack on the areas where there is inflammation or redness for 20 minutes, two to four times daily. This will help in easing the pain and will promote the healing.
- Stretching can help too. A strong and flexible arch can more easily bear the body’s weight when walking, jumping, and running without any injuries. And such properties are achieved through stretching exercises that are done once or twice each day for about 20 minutes. These exercises have some excellent benefits. They can break up the adhesions on the arch and enhance circulation to any micro-injuries or tears of the plantar fascia. Such exercises can also make the surrounding ligaments and muscles stronger and improve the flexibility.
Treatment for Chronic Plantar Fasciitis
There are several methods of treating plantar fasciitis when the condition becomes chronic or stubborn. This means that it becomes resistant to conservative treatments. In such cases, it would be well-advised to seek and explore other effective treatments:
- Extracorporeal shockwave treatment or ESWT. This is a non-surgical procedure which involves the use of shock waves to treat damaged arches. Some say it’s effective in treating chronic cases of plantar fasciitis without surgery although nothing is yet conclusive. Although non-surgical, the procedure involves some degree of pain.
- Intracorporal pneumatic shock therapy or IPST. The principle of this method is similar to the aforementioned ESWT. The difference is that the applied shock waves will be targeting the heel spurs. Local anesthesia is necessary but is a lot less painful than ESWT. Of those who underwent this procedure, according to a study, there is a 92% success rate in the reduction of pain.
- Radiation therapy. This is another non-surgical procedure which involves the use of radiation in small doses to deal with the damaged tissues of the arch. It has good advantages which include reasonable cost, very little side effects, and is non-painful. A study conducted about its effectiveness indicated that 80% of people had felt a complete relief from pain after the therapy. Also, 64% of these were still free of pain after 48 weeks.
- Surgery. This isn’t recommended and is used only with severe cases of plantar fasciitis. The surgery involves a partial removal of the injured plantar fascia ligament, release a part of the same or remove heel spurs. The operation is expensive and there is the possibility of potential complications. On a positive note, there is a high success rate with positive long-term results on many of those who underwent this method.
- Dry Needling. Through dry needling, the physical therapist can relieve the tension in the calf muscle at a second’s notice. Meaning instant pain relief from plantar fasciitis. Many are convinced that this is the most helpful way of dealing with fasciitis pain because patients are given relief immediately after a session of dry needling.
How does the treatment work? Well, it’s simple enough. Unlike the other procedures, dry needling works on the calf muscle rather than the plantar fascia ligament. We have earlier discussed the stiffness of the calf muscles and how this increases pressure on the plantar fascia ligament. By alleviating the tension in the calf muscle, it will also be reducing the pressure on the ligament and, consequently, pain is also reduced. To be more effective, combine this treatment with stretches of the Achilles tendon and the calf.
- Taping. This is another new innovation in dealing with plantar fasciitis pain. This procedure is simple too. It involves taping the affected area for pain relief. The biggest drawback of this technique is that it serves more like a painkiller rather than a cure, meaning the treatment will keep on working as long as one applies the tape. Once the tape is removed, the pain will come back.
Can One’s Diet Play a Role in Managing Plantar Fasciitis?
Most people who suffer from plantar fasciitis can treat themselves by applying ice to the affected area and resting. Performing strengthening and stretching exercises can also be very beneficial as these may promote healing and help prevent the occurrence of complications such as weakness or tightness of the other muscles of the foot. Despite all the efforts though, one would still need several months to recover.
Prescription medications and over-the-counter medications may help reduce some of the inflammation and pain that usually comes with plantar fasciitis. Shoe inserts and orthotics may provide the foot with the needed support and relieve the pressure too. Also, these can provide the person with short-term relief from the pain of the condition. However, in more severe cases, one may need to undergo surgery to treat plantar fasciitis.
Some people wonder whether diet plays a role in managing plantar fasciitis. There had been a study done where a patient with plantar fasciitis followed a gluten-free diet then went into remission. But this didn’t really establish a concrete cause-and-effect relationship. What we can be sure of is that certain types of food such as sugar, trans fatty acids, and dairy may contribute to various inflammatory conditions including plantar fasciitis. But this association hasn’t been established clearly in studies and medical literature.
One known risk factor for plantar fasciitis is obesity. Studies show that obese and overweight people have a higher likelihood of developing plantar fasciitis. Although it’s still unclear if their diet is a factor, trying to lose weight may benefit obese and overweight people a lot, especially health-wise. Doing this would also reduce the pressure on their heels since they would weigh less.
How Do You Prevent Plantar Fasciitis?
It’s much easier to prevent plantar fasciitis that it is to treat it. Fortunately, if a person follows some healthy habits, he can keep heel pain and plantar fasciitis at bay. Consider these tips:
- Try to avoid excessive weight gain. Chronic or rapid weight gain is a major risk factor for developing this condition. When a person is overweight or obese, this places a lot of strain on the plantar fascia ligament, the heels, and the balls of the feet. This, in turn, strains the arches which might lead to pain, inflammation, and eventually, plantar fasciitis. Following a healthy diet and eating the right foods which contain the essential nutrients can be very beneficial. Also, choose foods which have anti-inflammatory properties in order to protect you against the condition.
- Perform warm-ups before exercising. Some say that warming up before starting a workout is “good but not really necessary.” However, warming up and stretching the muscles before diving right into one’s exercise routine will have a good effect on how the tendons and muscles prepare for the exercises and respond to them. Also, tight muscles can’t stretch easily and are more susceptible to injuries. They won’t be able to perform as well and they won’t be able to support the other tendons and muscles including the ones found in the feet.
- Wear the proper shoes. In terms of preventing plantar fasciitis, the best thing a person can do is wear shoes which will provide support to the heels and the arches. The proper shoes would mean that they fit well, they have thick soles, they will cushion the heels, and they won’t allow the heels to wiggle or move around while walking or exercising. Never wear shoes such as heels which will strain the arches of the feet all throughout the day then just use the supportive shoes for exercising. All the shoes a person wears every day will have an effect on his feet’s health. Aside from avoiding unsupportive heels, flip-flops, and other kinds of improper shoes try to avoid going barefoot too.
A lot of people think that using orthotics and other supportive items is only for people who have full-blown foot issues. But this isn’t necessarily true. In fact, using such supports is a great way to “empower” the shoes one uses and help prevent plantar fasciitis from developing. Doing this is also a cheaper alternative to purchasing orthotic shoes which are a lot more expensive.
- Only run on soft surfaces. Even runners can keep plantar fasciitis at bay. The easiest way to do this is to run on soft and even surfaces as much as possible. Try to run on groomed paths or sidewalks whenever feasible. Running or jogging on soft surfaces will minimize the impact absorbed by the feet as they come in contact with the ground. This means that there’s less risk of stress and inflammation of the fascia and the heels. Also, staying away from uneven surfaces will mean less risk of straining or twisting a tendon or ligament or even of landing the wrong way.
- Try not to overdo it. Another great habit more people should start is to listen to their bodies and know their own limitations. This will help prevent plantar fasciitis as well as other types of illnesses and ailments. While exercising or performing strenuous activities, watch out for signs of exhaustion and pain. Do this while also focusing on the fitness goals one wants to achieve. This will help prevent the overexertion of tendons and muscles. If planning to increase the intensity and duration of workout routines, it’s best to do so incrementally.
- Stay active. Finally, it’s important to stay active. This might sound counterproductive but this will also help prevent plantar fasciitis. Exercising at least 15 minutes each day will maintain the flexibility, limberness, and health of the ligaments, tendons, and muscles of the feet. This, in turn, will allow your feet to support you better while also avoiding plantar fasciitis. The best part is, one doesn’t have to perform strenuous activities in order to stay active. A simple walk around the park, a few stretching exercises or even a friendly game of catch with one’s child can keep anyone active and limber.
All these healthy habits will help one prevent plantar fasciitis. Adding them to one’s fitness and health routine won’t just prevent the condition but also help the person enjoy life while remaining active. These healthy habits will also help the person prevent the pains that usually come with plantar fasciitis and other similar conditions. As long as the feet are healthy, there’s less risk and one can enjoy to the fullest!
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