Plantar Fasciitis is a really common connective tissue problem. It typically involves tenderness and irritation of the thick band of tissue at the end of your foot, which connects the toes and heel bones together. This ligament or thick band of tissue is termed as plantar fascia. This web-like ligament acts as a natural shock absorber and helps in supporting the arch of the foot, which helps in walking. Since, plantar fascia experiences a lot of wear and tear daily, therefore, putting excessive pressure can damage the ligaments. Once these ligaments are damaged, plantar fascia is inflamed and this tenderness then causes stiffness and heel pain which requires medical attention.
The good news is that most of the cases of Plantar Fasciitis can be resolved with the conservative treatment methods. For, the initial few weeks the patient is usually advised to rest, take pain killers, stretch and exercise and make changes in the daily activities. We’ll discuss details regarding the treatment below.
How to Differentiate Between Foot Pain and Plantar Fasciitis?
The most common question people usually ask is;
“How do you rule out ordinary foot pain from Plantar Fasciitis?”
Well, there are certain factors that can help you in differentiating between an ordinary foot pains from Plantar Fasciitis, which are:
- The pain worsens when you walk after resting or sleeping.
- You’ll have problem while lifting toes of the floor.
- The pain lessens after exercise but worsens again after prolonged resting.
Prevalence of Plantar Fasciitis:
The prevalence of plantar fasciitis along with severe heel pain is 0.85%. Not only this, plantar fasciitis is also the most frequent and common kind of orthopaedic complaint a patient comes in with. It is also the main cause of the heel pain. Moreover, almost 4% to 7% of the patient comes with the complaint of heel pain, and 80% of them get diagnosed with Plantar Fasciitis. It is more common in adults, overweight individuals and runners.
According to the analysis on the characteristics of Plantar Fasciitis, it was concluded that:
Almost 25% of the individuals with Plantar Fasciitis had severe pain, 45% of them had moderate and 28% reported mild pain.
The major complaint a Plantar Fasciitis patient comes in with is the stabbing pain near the bottom of the heel and mid-foot foot. The pain is typically intense, sharp and unilateral in 70% of the cases.
The pain is intense after resting and persistent periods of sitting. Moreover, the pain also worsens if the heel bears weight for longer periods of time. It can increase after long duration exercises but not during it. One foot is usually affected at one time, but both the feet can be affected as well.
The ligament, plantar fasciitis can rupture if overused. The main sign of this ligament rupturing is the snap or click sound along with swelling and severe pain at the bottom of the heel and feet.
Most of the patients with Plantar Fasciitis usually report that they have intense pain during the first few steps after resting and an improvement is observed after walking for a few minutes. Other rare but reported symptoms also include tingling, swelling, numbness and burning ache in the foot.
In short, the four main symptoms of Plantar Fasciitis are:
- Mid-foot pain
- Heel pain
- Tenderness and burning sensation near the heel, and
The diagnosis is mainly based on the medical history and the physical examination conducted by the GP. The doctor examines the tenderness near your heel along with the location of the pain to analyse its cause.
During the initial stages of Plantar Fasciitis no diagnostic imaging is required. Magnetic resonance and ultrasonography is usually required for intractable cases to exclude any heel pathology. Increased thickness of plantar fascia and abnormal tissue and ligament signal is usually the diagnosis of Plantar Fasciitis.
An X-ray can reveal the piece of bone that sticks out of the heel bone. This bone spurs can be the cause of heel pain and is often removed surgically. However, patients with bone spurs don’t experience heel pain.
Plain radiography can detect the bony lesion in your feet. The sub-calcaneal spur seen on the lateral foot radiography doesn’t diagnose plantar fasciitis. Different researches have shown that the sub-calcaneal spurs are also detected in patients without the plantar fasciitis.
The cause of plantar fasciitis is not quite clear. However, doctors usually say that Plantar Fasciitis is caused due to the excessive tension on the plantar fascia which can cause small tears. The strain injury to the ligament of the foot causes the disorder. Stretching and tearing repetitively can irritate the fascia resulting in plantar fasciitis. This injury usually results because of excessive walking and running, jumping injury while landing and inadequate foot gear.
Certain diseases like ankylosing spondylitis and reactive arthritis can also be the cause. However, the main cause is still unclear. According to study conducted in 2003, Plantar Fasciitis might involve degeneration instead of inflammation of the ligament, plantar fascia.
The ligament of the heel, plantar fascia, when overly stretched can tear from the surface. This can result in inflammation and burning ache.
Even though, anyone can end up having plantar fasciitis, but there are certain individuals who are more likely to get the disorder. Some people who are at a higher risk are:
1. Individuals who are 40-60 years of age:
Men and women between the ages 40 and 60 are more likely to develop plantar fasciitis. Men and women who are active throughout their life are at a higher risk of developing plantar fasciitis.
Plantar fasciitis is more common in women than men. There are two main reasons why women are at a verge of developing plantar fasciitis more often. First, women’s shoe preferences are mostly based on fashion and style rather than comfort. And second, they are more active than men, especially the mothers and working women. Moreover, pregnant women also develop plantar fasciitis because of the sudden weight gain during the pregnancy.
3. Overweight individuals:
You’ll be at a greater risk if you are obese. This is because obesity puts increased pressure on the ligament, plantar fascia which results in plantar fascia.
4. Individuals who wear thin sole shoes for a long time:
Wearing thin soles for a long time can be a risk for developing plantar fascia. With a thin sole, you won’t have necessary cushioning your foot needs, therefore you’ll be more prone to develop plantar fascia.
5. Long distance runner:
Runners often face the problem of plantar fasciitis. Other than this, you are also at a risk if you have an active job that involves most of your time standing. For instance, if you are working at a restaurant or a factory.
6. Tight heel cords or Achilles tendons:
Structural foot problems can be a risk factor for plantar fasciitis. Foot problems like flat feet, high arches and tight heels can result in plantar fasciitis. Furthermore, tight Achilles tendons (which are tendons that attach calf muscles and heels together) can cause plantar fasciitis as well. This can be cured by wearing soft sole shoes that can provide better arch support.
You can opt for going to a doctor as well as home remedies to treat plantar fasciitis. There are several distinctive options that have made the cure easier. We have discussed the different proven home remedies and other treatments of plantar fasciitis below.
Most of the people with plantar fasciitis take several months to recover fully with the conservative treatment. Conservative treatments or home remedies for plantar fasciitis include icing in the painful area, stretching, applying essential oils and resting.
Using an ice pack or an ice cube to massage the painful area tends to lessen inflammation. To cure plantar fasciitis, cover the ice pack with a towel (make sure the towel is thin), and hold it over the painful area for 15-20 minutes at least 2-3 times daily. This remedy has turned out to provide comfort and relief to some extent, but doesn’t treat plantar fasciitis completely.
Stretching and exercising before getting up can reduce the pain and provide comfort to the plantar fasciitis patients.
Apply essential oils:
According to a study conducted in 2015, lavender oil reduces inflammation which can make it a possible treatment for plantar fasciitis. By mixing lavender oil in a carrier oil like olive or coconut oil and then massaging it on your heels can help in reducing the pain caused by plantar fasciitis.
Therapies for Plantar Fasciitis:
There are different therapies to treat plantar fasciitis.
Physical therapy is one of the most important treatment for plantar fasciitis. It mainly involves a series of stretching exercises for Achilles tendon and plantar fascia which helps in strengthening your muscles, stabilizes your walk and reduces the workload on the ligament, plantar fascia. Other than this, a physical therapist also guides you to apply athletic taping to provide support to the bottom of the feet.
A physical therapist also recommends wearing splints which assists in stretching the calf and the foot-arch when you are sleeping. This holds the Achilles tendon and plantar fascia in an extended position that promotes stretching.
Furthermore, a doctor or a physiotherapist may also prescribe an off-the-shelf or customized arch supports – the orthotics, to even out the pressure on the feet more evenly.
Extracorporeal Shock Wave Therapy:
If the pain isn’t reducing, a general physician recommends an extracorporeal shock wave therapy. In this therapy, sound waves bombard the heels to speed up the healing inside the ligament. The therapy is used for chronic plantar fasciitis issue that isn’t responding to the other conservative methods. Different studies have shown promising results, but has not turned out to be highly effective though. Moreover, the therapy also involves some side effects like numbness, pain, swelling and bruises.
Different pain relievers are prescribed for the patient for temporary relief. Medications are usually preferred when the issue is mild. Doctors usually prescribe pain killers including ibuprofen (Motrin IB, Advil etc.) and naproxen sodium (Aleve) which can reduce the inflammation.
If the conservative methods aren’t working after months of treatment, then the doctor recommends other procedures which are:
If the medications and physical therapy doesn’t seem to work, then doctors opt for injecting steroid medication to provide temporary relief. The medicine is injected in the tender area for pain relief. Multiple shots aren’t given to prevent plantar fascia from weakening (weak plantar fascia usually ruptures, making the case worse). Besides, by using ultrasound imaging the patient’s platelet-rich plasma is obtained that promotes the tissue healing.
Ultrasonic Tissue Repair:
Ultrasonic tissue repair uses ultrasound imaging that helps in guiding the needle-like probe into the damaged part of plantar fascia. With the help of ultrasound energy, the probe tip begins vibrating that eventually breaks the damaged tissue which is then extracted out.
Plantar Fasciitis Surgery:
If none of the above method show effective result, then doctors opt for surgery. People with chronic plantar fascia need surgery to remove the plantar fascia from the heel bone. Doctors often opt for surgery when other methods aren’t effective and the pain gets severe over the past 6-12 months.
The surgeon removes the plantar fascia from the heel bone which ultimately lessens the tension. The only problem is that it wears off the arch of the foot, and function might be lost.
The physicians also suggest gastrocnemius recession, if you have an issue in flexing even after stretching. This type of surgery involves stretching the calf muscles to enhance the ankle motion and reduce stress on the plantar fascia.
Despite being the most effective treatment for chronic plantar fascia, it can cause chronic pain and nerve damage, which is why other treatments should be tried first, before preferring surgery.
Plantar fasciitis is a most common foot issue, which if not treated on time can lead to a severe heel problem. Thus, it is important to consult a doctor before the problem increases rapidly, and you have to opt for surgery. Curing the issue at an early stage with the conservative treatment methods can reduce the problem to a really great extent, possibly.
Prevalence of plantar fasciitis:
Symptoms and causes:
Diagnosis and treatment:
Applying ice for plantar fasciitis:
2015 study (essential oil for treating plantar fasciitis):