What is plantar fasciitis?
Plantar fasciitis is the medical term for tissue damage to and inflammation of the plantar fascia. The plantar fascia is the connective tissue on the sole of your foot that connects to the calcaneus (the heel bone) and then runs along the arch of your foot towards the toes attaching to the metatarsal bones. The plantar fascia has an important role in helping to support the arch of your foot. The plantar fascia tenses when there is increased weight put through the foot on activities like weight-bearing, walking and running.
Why & when does plantar fasciitis happen?
Plantar fasciitis is the most common cause of heel pain with a reported 10%of the population having suffered from the condition in their lifetime. Plantar fasciitis is an overuse injury resulting from repetitive micro trauma or occasionally one single high impact trauma that over stresses the fascia causing small tears to occur, most commonly at the attachment site to the heel. This condition is most commonly seen in dancers and runners due to the forceful and high impact nature of those activities. Obesity also increases the incidence of the condition due to the constant increase in weight load through the foot arches. Wearing inappropriate footwear with no arch support can also trigger the condition this is particularly seen during summer months when supportive winter shoes are swapped for flimsy flip flops. People who already suffer with flat feet (A.K.A pronated feet); a condition where the arches in the feet have fallen and even those with very high arches are much more likely to suffer from not only plantar fasciitis but intense calf muscle tightness and occasionally knee or hip problems due to the change in biomechanics through the foot. The condition is also seen in those who often walk for long distances like nurses; think how much they must walk on hard floors over a 12 hour shift! It is also a common complaint within hill walkers due to the uneven surfaces they walk on.
What does plantar fasciitis feel like?
Plantar fasciitis begins as a dull ache and stiffness along the sole of the foot that tends to be localised to the underside of the heel. This stiffness and ache tends to be at its most intense once rested after an activity in particular early in the morning, normally the first few steps you take out of bed are the most uncomfortable and stiff but will ease with movement. If untreated the condition will progress and the dull ache will intensify and the stiffness will worsen and instead of symptoms occurring after rest they will start to occur during the aggravating activities. In severe cases patients will walk with a mild limp. In most cases a local sharp tenderness is experienced when pressure is applied around the base of the heel this is often accompanied by mild levels of swelling.
How will plantar fasciitis be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis. In certain cases a heel spur may have formed at the tip of the calcaneus bone where the plantar fascia inserts, it is important to note that in these cases the plantar fasciitis is responsible for creating the spur and the pain is derived from the underlying plantar fasciitis not the spur.
Occasional your GP may want to refer you for MRI or ultrasound imaging to rule out other possible diagnosis like metatarsalgia or inflammation and damaged to the flexor digitorum brevis muscle.
What treatment options are available for plantar fasciitis?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any inflammation or swelling. Surgery is only considered in very severe cases and as a last resort due to the possible nerve damage complications. Occasionally corticosteroids injections may be used although conservative treatments are always favored for the treatment of plantar fasciitis.
Your therapist or GP will be able to provide you with exercises to strengthen the foot and ankle and also stretches for the calf muscles to aid the healing process and prevent reoccurring injury. Calf muscle and Achilles tendon stretches are particularly helpful for reducing the morning stiffness and tension. Many people find massage therapy helpful to loosen the affected plantar fascia and calf muscles, manipulative therapies such as physiotherapy, chiropractic and osteopathy are thought to help through mobilisation treatment of the foot working to reduce any stiffness levels and return the joints back to its normal movement.
Applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. A really good trick for icing plantar fasciitis is to put a full small water bottle in the freezer and once frozen take it out, sit down, keep your socks on and roll the affected foot over the frozen water bottle. This will not only ice the area but also give the fascia a gentle massage and stretch. Try to avoid all aggravating activities is advisable, however complete rest is not.
If your GP has mentioned or if in-fact you feel that there is some element of foot or ankle dysfunction such as flat foot or high arches that has predisposed you to this injury then it is very important that you see a podiatrist who can fully examine your feet and determine whether you need orthotics for your shoes. Often inappropriate and unsupportive running shoes are a factor in the development of plantar fasciitis the failure to correct this may result in the condition recurring.
It is incredibly important for people who are overweight to factor in weight loss as part of their treatment as it has been shown to help reduce the recurrence rate. If this is a concern then it is advisable to consult a dietician or nutritionist who can examine your daily diet and suggest where and what improvements you could make.