Plantar Fasciitis

The condition called plantar fasciitis is one of the most common causes of pain in the foot, specifically the heel. It is a painful heel syndrome that includes inflammation of a specific anatomical region of the foot, the plantar fascia, causing stabbing pain when taking steps.

Plantar fasciitis is the leading cause of heel pain. Characterized by stabbing pain in the heel when walking, it is caused by inflammation of a specific anatomical region of the foot from excessive wear and tear.

The plantar fascia is a thick band of connective tissue that runs across the bottom of your foot and connects the heel bone to the toes. When this fibrous tissue becomes inflamed, it is called plantar fasciitis.

Plantar Fasciitis vs. Heel Spurs

A heel spur is a hook of bone that can form on the heel bone of the foot. Like plantar fasciitis, it can be caused by long–term stress on the foot.

People confuse plantar fasciitis and heel spurs due to similar pathologies and symptoms. Both are located on and around the heel and can cause pain in this location.

One big misunderstanding is that heel spurs always cause foot pain. On the contrary, heel spurs or bone spurs often cause no symptoms.

We can differentiate between the two conditions by recognizing their different presentations of foot pain.

Studies have shown that most people over 50 with plantar fasciitis reported having disabling pain as opposed to a heel spur, which only causes pain to 1 in 20 people. Treatment of plantar fasciitis also differs from the treatment of heel spurs.

Symptoms of Plantar Fasciitis

As mentioned above, plantar fasciitis’ most common symptom is heel pain.

This heel pain is, however, different than general idiopathic heel pain. It has some particularities that will help doctors diagnose, differentiate, and treat it accordingly. Other less-recognized symptoms of plantar fasciitis include:

• Pain in the arch of your foot
• Stiffness
• Mild foot swelling
• Tight Achilles tendon

Heel Pain

The major complaint of those suffering from plantar fasciitis is pain at the bottom of the heel or the bottom of the foot in the plantar fascia region.

Usually, plantar fasciitis occurs only in one foot at a time, but it can sometimes affect both feet.

Plantar heel pain from this condition is known to develop gradually over time. The type of pain typically varies from person to person; it can be dull or sharp.

Others feel a burning or ache on the bottom of their foot, radiating outward from that initial point.

Plantar Fasciitis Pain

As mentioned, the pain is typically worse in the morning when taking the first few steps of the day and naturally improves throughout the day as the heel warms and loosens up.

Heel pain from plantar fasciitis typically flares up after long periods of activity; the pain is not usually felt during said activity but after stopping. This pain is due to increased irritation or inflammation of the plantar fascia.

Causes of Plantar Fasciitis

The exact cause of plantar fasciitis remains undefined.

The foot's plantar fascia is a tissue band connecting the heel bone to the toes. It supports the foot arch and absorbs shock when walking, running, or jumping.

Tension and stress on the plantar fascia can cause tiny tears. Unlike tears in muscles, years of fibrous tissue like the fascia can cause irritation or inflammation.

In turn, one will experience sharp pain when walking.

Although it is unclear what directly causes these conditions, researchers have found certain risk factors that may predispose an individual to develop this painful condition.

Risk Factors

Like every health condition, age is always a risk factor. In this particular condition, people aged 40 to 60 are more likely to experience it.

This fact is most likely due to the higher fragility of the tissues in the foot, all while still being relatively active at that age.

An 80-year-old with more fragile tissues will usually be more careful while performing physical activities.

They often will only perform these activities briefly due to other pain, discomfort, or health factors.

Using caution during certain activities, the elderly population becomes less likely to develop plantar fasciitis.

As mentioned, specific exercises can cause a lot of wear and tear on the heel and neighboring tissues. Activities such as long-distance running, ballet, and aerobic dancing can increase the risk of plantar fasciitis. Even prolonged standing can put one at risk.

The structure of one's foot can play a role in the likelihood of developing this issue. Specifically, flat feet, a high arch, or an abnormal walking or running gait can elevate the risk.

These particularities affect how weight is distributed throughout the foot, sometimes putting more stress than usual on the plantar fascia.

Putting more stress on the plantar fascia is one way to increase your chances of developing plantar fasciitis. Body weight is one factor that stresses this part of the foot.

Excess body weight can cause wear and tear to this part of the foot and increase the odds of developing plantar fasciitis.

Finally, occupational factors can increase one’s chances of developing plantar fasciitis.

Specifically, jobs that have one on their feet for long periods, like factory workers or healthcare workers, will put more stress on the plantar fascia and, in turn, lead to this condition.

Diagnosis of Plantar Fasciitis

Physical exams and other tests are necessary to diagnose plantar fasciitis.

Like many health conditions, your physician will perform a physical exam to check for signs such as:

• Tenderness
• Swelling
• Redness in the foot and the specific area of pain

This exam is to help rule out other foot issues that may cause pain or swelling in different regions of the foot.

A doctor may also request specific foot movements to assess the nature of the pain.

These movements can inform the physician whether the pain worsens or improves with specific motions, which can help rule out other prevalent orthopedic foot issues.

The physical examination may also include components to verify the health of nerves in the foot.

The physician will check for the following:

• Reflexes
• Muscle tone
• Coordination
• Sensation
• Symmetry

Doctors can get a solid hypothesis of plantar fasciitis with a physical exam, but imaging tests are required to verify these and to display structural and anatomical issues.

Treatment of plantar fasciitis is much simpler when there is a visual display of the problem.

Before continuing with treatments, tests such as X-rays or MRIs can rule out fractures and confirm plantar fasciitis.

Ultrasounds, although not as common in this case, can be used to observe any thickening, damage, or calcifications to the tissues in the foot.

Surgical Treatments for Plantar Fasciitis

Surgeries may be necessary to treat plantar fasciitis in severe or stubborn cases.

Conditions in which your doctor may recommend surgical interventions are as follows:

• Other treatment approaches are deemed unsuccessful and do not relieve chronic pain,
• Symptoms cause debilitating pain for at least 6 to 12 months
• The tension in the ligament has accumulated to the point of tissue degeneration
• Conservative approaches are causing more damage than relief.

One may receive surgery if the condition hinders one’s ability to work or complete activities of daily living.

Although usually very beneficial, surgical treatments are typically avoided unless necessary.

Gastrocnemius Recession

The gastrocnemius recession is a surgical procedure performed when non-surgical treatments have been attempted but have mostly proven ineffective. The primary objective of this surgery is to enhance the individual's quality of life.

When an individual with plantar fasciitis has tried physical therapy and all stretching exercises, the doctor may recommend this procedure to increase ankle mobility in the foot and release stress on the plantar fascia.

This surgery is done by lengthening the calf muscle and tendons at the back of the lower leg. This lengthening of the calf allows the heel to shift down into a more natural position.

Many patients have reported lower pain levels and increased mobility and activity after recovery from this surgery.

Plantar Fascia Release

Plantar fascia release is a surgical procedure with similar goals and benefits as the gastrocnemius recession. It is, however, only done in the most severe of cases.

This surgery involves making incisions or removing parts of the inflamed plantar fascia tissue with a lot of tension.

This surgery can help reduce inflammation and pain in the foot because it releases much of the plantar fascia's tension. This reduces pain and increases circulation and mobility.

Overall, after recovery, people typically experience a significant improvement in pain.

Nonsurgical Treatments for Plantar Fasciitis

Many people are not interested in surgical treatments for plantar fasciitis, and often, the condition is not severe enough to require these treatments.

Surgical treatments can be pretty invasive, especially for an aging person, and physicians will try their best to avoid this outcome. Many people can remedy their plantar fasciitis with nonsurgical treatment.

Medications and Steroid Injections

Many providers recommend over-the-counter medication to help with pain and inflammation, such as NSAIDs (non-steroidal anti-inflammatory drugs).

These can include:

• Aspirin
• Ibuprofen
• Naproxen.

These are known to decrease inflammation and, in turn, pain. By doing this, you can experience less pain and speed up the healing process.

A second class of medication commonly used for plantar fasciitis is corticosteroids. These are medications that significantly reduce inflammation. They can be in the form of a pill or injection.

Your doctor may prescribe steroid injections for plantar fasciitis. These injections are often recurrent until the problem has completely disappeared and often speed up healing while reducing pain.

Another essential part of the treatment plan for plantar fasciitis is rest. Taking breaks from the activities causing the pain is vital to heal this condition.

Rest and Icing

Although challenging, pausing or limiting physical activity to reduce pain can significantly improve the prognosis.

Inflammation is how the body protects itself against injury or infection. In the case of plantar fasciitis, the body is trying to protect against the injury. Inflammation can be significantly reduced by icing the affected area. Icing the foot for 10 to 15 minutes twice daily can dramatically improve healing.

Orthotics and Splints

Depending on the cause or the risk factors for plantar fasciitis, orthotics or shoe inserts and night splints may be beneficial.

If an individual has a flat foot or an abnormally high arch, orthotics can help fill those spaces and support the foot better. Night splints can be worn at home to provide support when the body is asleep.

This can prevent plantar fasciitis, speed up the healing process, and prevent the condition from progressing for the worse, such as plantar fascia rupture.

Not only are orthotics, night splints, and shoe inserts beneficial, but overall, supportive shoes are essential in reducing risk and improving the outcome of plantar fasciitis.

Worn-out shoes are one of the most common ways to cause wear and tear to the foot. With worn-out, soft soles, they provide poor arch support and can even cause foot arch problems and flat feet.

Wearing shoes that are not only right for each individual but are supportive and of good quality has shown that plantar fasciitis improves with this.

Physical Therapy

When working with individuals with plantar fasciitis, physical therapies focus on treating the condition by stretching the plantar fascia, the Achilles tendon, and the calf muscles.

This approach aims to improve tissue health and alleviate tension in the Achilles tendon as a part of the treatment for plantar fasciitis.

By stretching, the flexibility of these muscles and tissues is improved, and, in turn, heel pain is decreased.

Physical therapy exercises focus on the foot building stability throughout the leg and reinforcing the affected muscles and plantar fascia. Having strong calf muscles means a strong plantar fascia.

Shock Wave Therapy

Shock wave therapies, such as extracorporeal pulse activation technology, are great for treating plantar fasciitis.

This is done by applying concentrated acoustic sound waves to increase blood flow to the plantar fascia. This promotes quicker healing.

Stretching Exercises

Like physical therapy, stretching is a great way to loosen the affected muscles and tissues, reduce pain and inflammation, and promote blood flow for healing.

A physical therapist can provide some foot stretching exercises to perform at home, or similar exercises can be found online. There are many videos to demonstrate a variety of ways to stretch the plantar fascia properly.

The Prognosis for Plantar Fasciitis

Thankfully, plantar fasciitis does not usually cause chronic pain and often has a good prognosis.

For most, plantar fasciitis can improve within a few months of treatment. Sticking to the recommended medical or home treatments is the surest way to improve the outcome.

Ignoring plantar fasciitis or not adhering to the prescribed plantar fasciitis treatment can lead to chronic heel pain and chronic plantar fasciitis that affects activities of daily living.

By ignoring the pain and not completing treatments, an individual’s gait will change as the body’s way to avoid the pain in the plantar fascia; this can often lead to foot, knee, hip, and back pain and chronic problems in these areas.

References

Plantar Fasciitis: Symptoms, Causes & Treatment Options

Plantar Fascia Release Surgery | Resurgens Orthopaedics

Plantar fasciitis - Symptoms and causes

Plantar Fasciitis: Causes, Symptoms, Treatments, and More

Plantar Fasciitis - StatPearls - NCBI Bookshelf

Evaluation and Treatment of Chronic Plantar Fasciitis - L. Daniel Latt, David Eric Jaffe, Yunting Tang, Mihra S. Taljanovic, 2020

Therapeutic considerations for patients with chronic plantar fasciitis (Review)

Disclaimer

The contents of this article are provided for informational purposes only and are not intended to substitute for professional medical advice, diagnosis, or treatment. It is always recommended to consult with a qualified healthcare provider before making any health-related changes or if you have any questions or concerns about your health. Anahana is not liable for any errors, omissions, or consequences that may occur from using the information provided.