Is Plantar Fasciitis Chronic? – Diagnosis, Symptoms & Treatment

Plantar Fasciitis mostly happens because of the injuries that have happened over time. Even though treatment can ease the pain to some extent, it takes some time before the foot is completely okay. However, even this time can vary from a few months to a year.

In some cases, the condition can become chronic. For some individuals, the condition improves but then reappears and in other cases, it can remain consistent.

Primary treatment should consist of nonsteroidal anti-inflammatories (NSAIDs), stretching of the gastrocnemius and plantar fascia, and the use of an orthosis (heel cups, heel pads, arch supports, or night splints).

Structure and Function of Plantar Fasciitis:

The plantar fascia is a ligament and is basically a thick band of tough connective tissue spreading over the curve from the back tuberosity of the calcaneus to the root of the proximal phalanges.

Recent researchers have suggested that plantar fasciitis is an aponeurosis rather than an accurate fascia. Dorland’s Medical Wordbook defined aponeurosis as:

  1. A ribbon-like tendinous enlargement, that joins a muscle with the parts that it moves.
  2. A term anciently applied to certain sashes.

The Plantar Fascia:

The plantar fascia has lengthwise organized connective tissue. The origin of these tissues is the periosteum of the tubercle. These are thicker in the center and thinner on the outside. The midsection of the ligament is extended into five ligaments.

Plantar fascia pain can be introductory or non-introductory and affect the larger central ligament and include the medial and lateral ligament of the plantar fascia. It binds with the Parthenon of the Achilles tendon, the foot’s intrinsic muscles, the skin, and the subcutaneous tissues. The thick multilobular fat pad absorbs up to 110% of the body weight when walking and 250% when running and is most deformed when walking barefoot compared to walking poorly.

“The question here arises, that is plantar fasciitis chronic?”

Most of the plantar fascia cases are chronic, and the pain appears slowly and begins to worsen over time. Therefore, make sure that you consult a doctor before your condition gets worse.

The word chronic means continuing for a long span of time or occurring frequently. So just like that, a chronic disease is the type of condition which worsens overtime and is persisting for a long time or constantly.

Difference between Acute and Chronic Types of Plantar Fasciitis:

The two main kinds of the condition are discussed below.

Acute:

This disease can be caused by certain injuries and is also known as the acute type.

Chronic:

The chronic plantar fasciitis develops persistently and frequently and gets worse with time (if left untreated).

What is the difference?

Acute plantar fasciitis typically occurs suddenly but for a short duration, for a few weeks or, in some cases, just some days. Whereas, chronic plantar fasciitis forms slowly and gets worse with time.

Diagnosis:

In plantar fasciitis, the patient usually experiences pain in the heel. The plantar fasciitis pain is usually worse in the morning or after long durations of rest.

Doctors and physicians look into different risk factors to examine the adequacy of the different activities and choices of orthotics and shoes for the patients. For accurate diagnosis, it is important to check the musculoskeletal system of the feet.

The deformity of the planus foot can be determined. There are certain things based on which the diagnosis is made. These factors include the patient’s history, tests and physical examinations and risk factors. Inflammation, tightness and pain in the heel are some of the most common symptoms of plantar fasciitis which intensify when you wake up in the morning and after sitting for a longer duration.

The heel pain can improve by exercising and walking around, but standing or walking for a longer duration is not advised since it causes pain and inflammation.

Symptoms of Chronic Plantar Fasciitis:

The pain caused by the damage of plantar fascia is quite severe and mainly affects the heel. The patient experiences intense pain during the first few steps after long spans of resting and after waking up. However, the pain can also increase if the patient stands for a long time. Pain caused by plantar fasciitis is more after the workout and exercise and not during it.

Complications of Chronic Plantar Fasciitis:

Ignoring plantar fasciitis can lead to chronic heel pain that makes your normal activities difficult. One way to make the pain better is by changing the way you stand, walk and run. If you don’t focus on the problem on time, the consequences can be bad leading to other issues like back, foot and hip problems.

Risk Factors of Chronic Plantar Fasciitis:

There is no obvious cause of plantar fasciitis, however, there are some risk factors that can result in causing plantar fasciitis, age factor being amongst it. People between the age of 40-60 are most likely to develop plantar fasciitis.

Distinctive exercises including ballet dancing, marathon running, aerobics and exercises putting stress on the heel can result in plantar fasciitis.

Other than this, high arches, flat feet and different gait patterns can also be the cause of plantar fasciitis.

Standing for a long duration of time without resting can also be the risk factor which is why factory workers, salespersons, teachers, and others who spend most of their working hours walking or standing on hard surfaces can damage the plantar fascia.

  1. Excessive Running
  2. Excessive Foot (Pes Planus)
  3.  High Arch (Pes Cavus)
  4.  Leg Length Discrepancy
  5. Obesity (Body Mass Index)

When the doctors conduct an examination, the patient is asked to walk in the horse position to avoid excessive pressure on the heel.
Ankle or toe bending and contraction can cause tenderness and irritation in the proximal plantar fascia; it can also assess the tightness of the Achilles tendon.

Causes:

The ligament plantar fascia is shaped like a bowstring. This not only supports your foot but also protects it against shocks. The ligament damages when there is too much pressure on the plantar fascia.

Treatment for Chronic Plantar Fasciitis

There is no single treatment for plantar fasciitis. Several different types of medicines, treatments and remedies are used to make sure the plantar fascia recovers quickly. But the conservative treatments don’t work if the symptoms have not been solved within the first few months (three to six months) after being resolved.

Corticosteroid Injections:

Given the compelling evidence that chronic subcalcaneal heel pain results from a degenerative process, the rationale for using currently available therapies must be revalued. For instance, corticosteroid injections are often used for patients who are suffering from inflammation and heel pain.

The majority of surgeons often use surgery for treating plantar fasciitis. The procedure is known as an open plantar fasciotomy. The treatment has become effective, but it can come with different issues, including nerve injuries, plantar fascia rupture, and arch destabilization.

Augmenting Local Hemodynamics:

An emerging treatment that focuses on augmenting local hemodynamics, presumed to play a major role in the lubrication of plantar fasciitis cases, needs to be considered to fill the therapeutic gap between ineffective conservative care and invasive surgical options.

Augmenting local hemodynamics helps in the lubrication of plantar fascia and assists in filling the gap between the surgeries and conservative treatment.

Conservative Approaches:

Most of the plantar fasciitis cases automatically improve in six months to a year with the conservative treatment approaches.
There are different treatments opted by patients with plantar fasciitis. Conservative approaches of the first choice include rest, massage, warmth, ice, and calf strengthening exercises.

Distinctive techniques for stretching the muscles, tendons and plantar fascia are used to improve the condition. Other than this, obese patients can opt for weight loss remedies so that there is less body pressure on the feet.

Moreover, NSAIDs are also used to reduce the inflammation and pain of the plantar fascia. NSAIDs are often used by patients but they cannot relieve the pain in every patient. Even with the NSAIDs 20% of the people remain affected and are not fully healed.

Doctors often recommend conservative approaches for treating plantar fasciitis, however, if the conservative treatments don’t work then extracorporeal shock wave therapy is considered.

After the treatment, there is significant pain relief for around one year. However, the debate about the efficacy of the therapy has persisted. TOCH is performed with or without anesthesia, although studies suggest that administering anesthesia decreases the effectiveness of the procedure. Complications of HTO are rare and generally benign when present.

Orthotic Devices:

To reduce the pronation, different taping techniques and orthotic devices are used. This helps in reducing the stress on the ligament and decreases the pain and inflammation. The long-term efficacy of custom orthoses in reducing plantar fasciitis pain requires further study.

Plantar Iontophoresis:

In this technique different anti-inflammatory substances are used (like acetic acid etc), which are applied topically and transmitted through electrical current. Night splints have also turned out to be effective if used consecutively for 3 months.

Conclusion:

Plantar fasciitis is acute and chronic but the prevalence of chronic plantar fasciitis is more. Both of these plantar fasciitis need to be taken seriously at the start before the condition worsens. If the injury increases you won’t be able to do mandatory work like going to your job, sport, etc. It will also affect your walking style and make you unstable while walking or standing.

Plantar fasciitis can be destructive to one’s fitness if it is not taken seriously. As it gets worse overtime therefore prefer taking a proper medication such as NSAIDs, night splint, seeing a physician, stretching of legs, taking proper and perfect exercise for your plantar fasciitis. You can also place some ice over the area where you are experiencing the pain for 15-20 min, almost 5-8 times a day.

Chronic plantar fasciitis can lead you to severe issues which will require surgery if not taken seriously from the beginning.

References:

  1. https://en.wikipedia.org/wiki/Plantar_fasciitis
  2. https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846
  3. https://jaoa.org/article.aspx?articleid=2210626
  4. https://www.ortho.wustl.edu/content/Education/3689/Patient-Education/Educational-Materials/Plantar-Fasciitis-FAQs.aspx
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325390/
  6. https://journals.sagepub.com/doi/full/10.1177/2473011419896763

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