What Is Plantar Fasciitis?
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At the bottom of the foot, there is a long strip of connective tissue that runs from the ball of the foot to the heel, called the plantar fascia. Its role is to provide support for the arch on the bottom of the foot. Given its location on the bottom of the foot, the plantar fascia is highly susceptible to injury or strain.
Strain sustained by the plantar fascia can lead to tiny tears along the ligament tissue, irritation, and inflammation. Inflammation of the plantar fascia can cause increased pressure placed on the surrounding tissue, nerves, and other structures, which may lead to severe pain.
It is common for patients with plantar fasciitis to report the most severe pain upon waking in the morning. Additionally, plantar fasciitis patients frequently describe sharp pain upon placing weight on the feet following an extended period of sitting. Initially, the pain can be so severe that it causes the individual to limp; however, as the patient begins to move around, the stiff ligament is stretched, and becomes more loose and flexible.
Other commonly reported symptoms of plantar fasciitis include:
- Pain, discomfort, and achiness within the arch area
- Stiffness within the heel
- Stiffness of the arch
- Tenderness at the bottom of the foot
- High arch
- Flat feet
- Difficulty going up steps
Diagnosis of plantar fasciitis generally includes a physical examination. During this examination your physician will evaluate the location of the pain and assess the degree of swelling. The physician will also ask a number of questions regarding the course of the pain, any recent injuries or physical trauma sustained in the area, your personal history, and any relevant family history. This information is relevant in assisting the physician in determining the underlying cause of the pain.
Causes Of Plantar FasciitisExcessive strain placed on the bottom of the foot is the most common cause of plantar fasciitis pain. Strain, overuse, or excessive stretching placed on the plantar fascia leads to the development of small tears along the ligament tissue, inflammation, and pain. In most cases of plantar fasciitis, the pain is described as having a sudden onset, though there is a small group of patients who report that their symptoms developed more gradually and have worsened over time.
Injury and strain to the plantar fascia can be caused by an inadequate warm-up routine before engaging in strenuous exercise. Individuals who do not properly stretch and warm up before a new activity that involves physical exertion are at risk for causing damage to their plantar fascia, in particular among individuals who have had an extended period of inactivity.
Plantar fasciitis occurs more frequently among men, particularly between the ages of 40 and 70. Pain and discomfort associated with plantar fasciitis can happen to anyone. Several factors that have been shown to place an individual at greater risk for suffering from plantar fasciitis include alcoholism, liver disease, smoking, history of bone spurs, diabetes, thyroid problems, increasing age, and obesity.
Treatments For Plantar FasciitisPatients with more mild symptoms of plantar fasciitis can generally achieve improvements in pain and discomfort with at-home treatments. For example, your physician may recommend that you give the plantar fascia ligament plenty of rest following the injury. This will give the tissue time to properly heal. Your physician may also recommend applying a cold compress to the area. This will help with reducing swelling. Cold compresses using ice can generally be applied twice a day for ten to 15 minutes. Patients are cautioned against leaving the ice pack on the area for longer than 15 minutes, as this may cause surface tissue damage.
Physical therapy may also be recommended for treating plantar fasciitis. Specifically, the patient is instructed on how to do highly specified stretches and other exercises. The goal of these exercises is to loosen and strengthen the damaged plantar fascia ligament. Your physician may also suggest that you wear a splint on the foot at night, and speak with you about the importance of proper footwear. Patients with plantar fasciitis should ensure that their shoes provide adequate overall cushioning and support, as well as sufficient arch support. Proper arch support not only prevents the arch from falling, but it also reduces the risk of strain to the plantar fascia.
Patients with plantar fasciitis should ensure that they are allowing plenty of time for the ligament tissue to begin the healing process. In fact, full recovery from injury to the plantar fascia ligament may take a month or more, though the patient may no longer be experiencing any symptoms of pain or discomfort to the area.
Patients may take an over-the-counter (OTC) pain reliever. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be particularly beneficial for providing pain relief, as these medications also help relieve inflammation. Oral corticosteroids, such as cortisone or prednisone, may be prescribed for patients whose pain was unresponsive to OTC medications.
Some cases of plantar fasciitis can lead to chronic, unremitting pain that requires more significant intervention. In these instances, the pain has resulted in impairments in the individual’s ability to perform typical daily activities. For these patients, steroid injections, such as intra-articular steroid injections, may be recommended. This procedure provides highly effective and almost immediate relief from severe pain by interfering with the transmission of pain signals to the spinal cord and brain. The procedure is non-invasive and can be done in an outpatient setting.
Though relatively rare, some instances of plantar fasciitis pain are unremitting despite numerous treatment attempts. In these cases, surgery may be the only option. The procedure typically utilized to relieve the symptoms associated with plantar fasciitis involves cutting the plantar fascia ligament to relieve excess tension.
ConclusionOne of the most common pain conditions affecting the heel and foot is plantar fasciitis. This condition is characterized by pain, discomfort, stiffness, and swelling within the arch and along the bottom of the foot. Plantar fasciitis pain typically has an acute onset as the result of an injury; however, some instances of the condition may occur more gradually. There are a number of treatment options available. These may range from more conservative interventions, such as physical therapy, to more interventional forms of treatment, including steroid injections. In rare cases, surgery may be recommended to provide pain relief.
- Fallat LM, Cox JT, Chahal R, Morrison P, Kish J. A retrospective comparison of percutaneous plantar fasciotomy and open plantar fasciotomy with heel spur resection. J Foot Ankle Surg. 2013;52(3):288-90.
- Fox TP, Oliver G, Wek C, Hester T. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis. BMJ Case Rep. Aug 2013.
- Lee HS, Choi YR, Kim SW, Lee JY, Seo JH, Jeong JJ. Risk factors affecting chronic rupture of the plantar fascia. Foot Ankle Int. Nov 2013; [Epub ahead of print].
- Lee WC, Wong WY, Kung E, Leung AK. Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis. J Rehabil Res Dev. 2012;49(10):1557-64.
- Tahririan MA, Motififard M. Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci. 2012;17(8):799-804.
- Walther M. Kratschmer B, Verschl J, Volkering C, Altenberger S. Kriegelstein S., Hilgers M. Effect of different orthotic concepts as first line treatment of plantar fasciitis. Foot Ankle Surg. 2013;19(2):103-7.