What is Plantar fasciitis
Did you ever scream with severe pain in heel of your foot while put your first few steps out of your bed in the morning? What.. you said yes? ok, you may be suffering from Plantar Fasciitis (fashee-eye-tiss). In this article, I will explain all about plantar fasciitis, plantar fasciitis symptoms, heel pain, sore feet, foot pain and other foot problems.
Plantar fasciitis means inflammation of your plantar fascia muscles. It is an overuse injury-disease that affects the sole of your foot and generally goes in time. The treatment however may help speeding the up recovery from disease. Most common treatments include taking rest as much as you can, wearing good shoes and some specific stretching exercises. Temporary relief from pain will require taking painkillers. If the pain is sever, your doctor may recommend you a steroid injection.The Plantar Fascia is a special tissue ligament which acts as a shock-absorber in your foot. It is a strong fibrous band of tissues stretched from your heel (Calcaneus) up to your middle foot bones and supports the arch of your foot. When this plantar fascia tissue becomes ruptured, swollen, thickened or inflamed we would call it the plantar fasciitis. Plantar fasciitis is one of the most common causes of heel pain. It is particularly common in runners and aesthetes. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.
You can think the plantar fascia look like a series of fat rubber bands, but made up of collagen instead of rubber. The collagen is a rigid protein which is not very stretchy. Stress of overused shoes can rip tiny tears in the plantar fascia causing pain and inflammation which is called the plantar fasciitis
Plantar Fasciitis Symptoms
People suffering from plantar fasciitis feel the pain like a sharp stab or deep ache in the middle of their heel or along with arch. Mostly the pain of plantar fasciitis attacks when people take their first steps after they just get out of their bed in the morning or from a long siting.The stiffness and pain may be reduced after taking a few steps. But if not taken care, your foot may hurt more with the time. If the foot pain doesn’t not occur in morning and occurs in night or so, it may be a different problem i.e. nerve issues, arthritis etc.
Most common symptoms of plantar fasciitis include
- Pain and stiffness when you take your first steps in morning, also called the “first-step pain” is the main symptom. It may also occur when climbing stairs.
- Though mostly occurs right beneath your heel but it can be anywhere in the area of Plantar Fascia. You will find one spot as the main source of pain often about 4 cm forward from your heel.
- The plantar fasciitis pain may also be triggered after a long period of rest, such as after a long car ride. or long sitting in office. The pain decreases after a few minutes of walking.
- Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near your heel in the morning when you take your first steps.
- The pain may develop gradually over time, but can come all of a suddenly after an intense activity.
- You may feel the severe pain after exercise. Did you pay attention to “after exercise”, not “during “exercise”?
- Plantar fasciitis can occur either in one foot or both the feet. The pain may also be triggered after standing for awhile. A long walk or standing on your feet for a long time often makes the pain worse. Ensure to take rest properly.
- Though the plantar fasciitis is common in middle-aged people only but sometimes it may also occur in younger people who remain on their feet most of the time such as runners, athletes, policeman and soldiers.
- Plantar fasciitis is generally caused by straining the ligament that supports your arch. If the straining is done repeatedly it can cause tiny tears in the ligament which is the main reason behind plantar fasciitis.
Causes of Plantar Fasciitis
Plantar fasciitis is common in men and women and there are number of factors which can develop plantar fasciitis. It is more common in men who are over-active after age 40.By far you know that plantar fascia acts like a shock-absorbing band which absorbs the high stresses and strain we put on our fee. Plantar Fascia are the connecting tissue which connect heel and the base of toes and also support the arch in our foot. If the repeated and severe strain is put on plantar fascia it can cause tiny tears and inflammation in the ligaments. The body’s natural response to this tear and injury is inflammation and this inflammation is called plantar fasciitis.
Most common causes of plantar fasciitis include
1. Wearing torn, old or poor shoes with poor arch support or having soft soles
2. If you are overweight or gained weight suddenly, you are more likely to get plantar fasciitis
3. Person running long distances are also at risk
4. If a person is having a tight Achilles Tendon, this can reduce the flexibility of his ankle and make him more likely to damage his plantar fascia. The Achilles Tendon is the big tendon at bottom of your Calf Muscles above your heel.
5. The rupture of plantar fascia may be caused by drastic or sudden increases in running, being on your feet, wearing old or uncomfortable shoes, poor foot structure which can put the over strain on plantar fascia. This is a painful situation and make walking more difficult.
6. Earlier the Heel Spur was commonly thought to be a cause for plantar fasciitis and pain in heel. However, that is a subject to research as in it has been seen in latest researches and the x-rays shown that the heel spurs were found in people with and without plantar fasciitis pain.
7. If you have recently changed your exercising surface for example started running on the road instead of a track, this can cause plantar fasciitis.
8. If you keep standing on your feet for a long time, do lots of walking, lots of running etc. chances are high for you to suffer from plantar fasciitis.
9. Being overweight puts extra strain on your heel and is a very common reason of plantar fasciitis after age of 40 years.
Plantar Fasciitis Diagnosis and Tests
Usually we do not need any special test to diagnose the plantar fasciitis. Your doctor can simply diagnose plantar fasciitis by physically examining your feet and asking few questions about pain. Plantar fasciitis pain mostly occurs when you put your first few steps out your bed in the morning.
1. Symptoms that your Doctor will check in Physical Examination
- During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine the cause.
- If you flex your foot or pushes on the plantar fascia, the pain gets worst. The pain improves when you point your toes down.
- Doctors can also check for flat feet or high arches, mild foot swelling or redness, stiffness or tightness of the arch in bottom of your foot.
- They can also look for an area of maximum tenderness on the bottom of your foot, just in front of your heel bone.
In rare cases your doctor can suggest x-rays to see clear images of bones. It helps to determine if there isn’t any other bones related problem which is causing pain such as fractures or arthritis. Heel spurs too can be seen on an x-ray. Earlier these heel bone spurs were often assumed to be the reason of heel pain but it is not the case as of today. Many people who have bone spurs on their heels have no heel pain.
3. Ultrasound Scan and MRI
Though not very common but sometimes the Doctor can ask for Ultrasound scan or MRI (Magnetic Resonance Imaging) . If the initial diagnose and treatment didn’t work, these tests are generally done to make sure if the pain isn’t being caused by any other problem such as a fracture or a pinched nerve.
An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.
Who is at Risk?
- Women who stays on feet most of the time
- Who have those extra pounds on their body. Being overweight and obese put extra stress on your plantar fascia and increased the risk of plantar fasciitis.
- Men who are overactive after age of 40
- Persons in occupation which keep them on feet most of the day such as athletes, people in standing job, factory workers etc.
- Who do lots of walking or standing on hard surface, running extensively for exercise.
- People with very flat feet or very high arches are more likely to have plantar fasciitis.
- Who wear torn, old or uncomfortable shows with soft sole which puts strain on plantar fascia
Prevention of Plantar Fasciitis
- Keep your Ankle, Achilles tendon, and calf muscles flexible making it a habit to do some flexibility exercise. Stretch your plantar fascia in the morning before you get out of bed.
- Burn those extra pounds from your body and keep your weight under control.
- Wear only comfortable, shock absorbing and foot supportive shoes.
- Take special care when starting exercise or increasing the intensity of it.
- These little cautions can keep you away of painful plantar fasciitis.
Complications of Plantar Fasciitis
Complications of plantar fasciitis are worst if you don’t treat plantar fasciitis in time. It may become a chronic disease and the person may not be able walk a few steps. It may become a chronic heel pain that can stop all your overall routine activities.
To minimize pain the suffering person changes the way of walk which is not less dangerous even. Changing the way you walk can develop other complications i.e. other foot problems, knee pain, hip or back problems.
Myths About Heel Spurs and Plantar Fasciitis
Though patients of plantar fasciitis also reported to have heel spurs several times but spurs are not the cause of plantar fasciitis pain. There are many people who have heel spurs but not that bad pain. The treatment of pain of plantar fasciitis does not require to remove the heel spur.
Treatments and Therapies for Plantar Fasciitis
Treatment generally takes longer and involves taking rest and stretching exercises. The treatment can take few weeks, few months or few years in some cases.
Mostly the treatment of plantar fasciitis involves physical stretching exercise. Though your physiotherapist can help you guiding the right way of doing exercise but there are many exercises that you can do at home and will help you recovering from plantar fasciitis. Remember, taking rest as much as possible is the key of improvement; and no treatment will work if you do not rest. The idea is to keep your plantar fascia away from strain.
You can take pain killers such as acetaminophen (Tylenol), Ibuprofen (Advil, Motrin) etc. to control pain. Your doctor sometimes can also suggest steroids if severity of pain is high.
Treatments such as orthotics, foot taping, cortisone injections, night splints, and anti-inflammatory medicine decrease symptoms significantly in about 95 percent of sufferers within six weeks.
1. Maintain a healthy weight
An important factor to treat planter fasciitis is to reduce strain on fascia by keeping your weight low. Do regular exercise and eat healthy food to lose your weight effectively.
2. Massage Therapy
Most recommended massage therapies include
Massage Your Foot by a Golf Ball – when you first see the sign of soreness, massage your foot by rolling a golf ball under your foot.
Apply Ice – Apply ice and massage ice gently on the pain area. Apply ice to the painful area. To reduce pain and swelling, try putting ice on your heel. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.
Ice Bottle Massage – Roll a frozen bottle of water under your foot. Do this at least 3 times a day for 15 – 20 minutes, more often in the first couple of days.
Best Time to Stretch and Massage – The massage and stretch must be done on both feet notwithstanding you feel problem in only one foot. Best time to massage is the first thing in morning following three more times during the day.
Take Rest – No other treatments will work if you do not take enough rest. Taking rest is the key of treatment of plantar. Decrease or even stop the activities that make the pain worst, before you plan to take treatment. Resting as much as possible for at least a week. Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces
3. Orthotics Therapy
Wearing Heel Pad or Shoe Inserts – Your doctor may suggest you to wear heel cups or custom-fitted arch supports (orthotics) to help distribute pressure evenly on your. Try wearing a heel cups or shoe-inserts in the shoes to give extra support to arch. Wear heel cups or shoe inserts in both shoes, even if pain is in only one foot.
Wear Proper Comfortable Shoes – It really makes the different what you wear on your feet when you’re not running. wear shoes with good support and cushions. Avoid high heels, prefer shoes with good arch support and shock absorbency. And never walk barefoot, especially on hard surfaces.
Don’t wear worn-out athletic shoes – Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 500 miles of use.
Wear Walking cast or Boot Cast – Depending on situation, your doctor may suggest you to wear a walking cast for 3 – 6 weeks. A boot cast is a special shoes which looks like a ski boot. Do not wear old shoes rather get a new pair of shoes. This ensures that your foot is held in a position that allows the plantar fascia to heal-in and stretched.
Arch support – Make sure to wear something which supports your arch well. If you walk around barefoot or wearing soft sole shoes, it will delay the recovery from plantar fasciitis.
Physical Stretch Therapy – Your doctor most probably is going to suggest that you work with a physician to get some physical therapy that focuses on stretching your calf muscles and plantar fascia. Stretch therapy is the most important and required part of treatment of plantar fasciitis however Including all stretching therapies in this blog is out of scope of this blog. You can read about all the stretching exercises in my other blog “Stretch Therapy to Recover Plantar Fasciitis.”
Don’t Ignore – If the pain continues more than three weeks, don’t ignore. Immediately see a doctor or physiotherapist preferably sports podiatrist.
Night splints – Use night splints while sleeping to stretch the injured plantar fascia and allow it to heal. If other treatments are not helping much, your doctor may recommend splints to wear at night. Most people sleep with their feet pointed down. This relaxes the plantar fascia. Then in morning when we put our first step on a surface, the plantar fascia cells stretches and being one of the reasons for morning heel pain. A night splint keep the fascia stretched while you sleep. Although it can be difficult to sleep with a splinter initially but a night splint is very effective in recovering from planter fasciitis. Believe me you do not have to use it once the pain is gone.
Stretch your arches – Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
4. Extracorporeal shockwave Therapy (ESWT)
If the disease is chronic, older than 6 months and pain is sever, the shock wave therapy may also be prescribed by the doctor. Shock wave therapy for plantar-fasciitis treatment is approved by FDA. Extracorporeal shock wave therapy does not involve any actual incisions being made rather it uses a high intensity shock wave which stimulates healing of the plantar fascia. During ESWT, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. Read more about shock wave therapy.
5. Medicinal Treatments
Anti-inflammatory Medications – Commonly known as pain relievers needs to be taken to get relief from heel pain. Most common medicine include Acetaminophen (Tylenol), ibrufen (Advil, Motrin) and Aleve. Take the medicine in supervision with your doctor only. Some of these medicine can cause stomach problems and your doctor can prescribe a different medicine in case.
Steroid Injections – Your doctor may prescribe the steroid injection such as cortisone if the pain is severe. These anti-inflammatory steroid injections are injected directly into the tissue around your heel and may temporarily help in reducing pain. Steroids are not generally recommended causing other side effects and complications if taken very often. The complications may include shrinking of the fat pad of your heel, which you need for insulation which could indeed increase your pain or could even rupture the plantar fascia in long run.
6. Surgery for Plantar Fasciitis
You doctor may probably will not recommend you the surgery being associated with some potential complications after surgery. Doctors will only suggest a surgery for plantar fasciitis if all the aggressive non-surgical treatments got failed at least for 12 months.
There are two kind of surgery involved for plantar fasciitis.
Plantar Fascia Release – This is the most common surgery for plantar fasciitis . If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure in which a portion of the plantar fascia is released from the heel .
Though A plantar fascia release can be performed through a regular incision or as endoscopic surgery, it is a risky process and can damage the nerves. Endoscopic surgery is even more difficult than with an open incision and having higher risk of nerve damage. Additionally after any surgery, there is still some chance that you will continue to have pain afterwards. You must be very cautious while choosing your doctor, if going for surgery.
Gastrocnemius Recession Surgery – If you still have difficulty flexing their feet, despite a year of calf stretches exercies, your doctor may suggest you Gastrocnemius Recession Surgery . It involves a surgical lengthening of the calf (gastrocnemius) muscles. Tight calf muscles place increased stress on the plantar fascia.In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. This procedure can be done either with a smaller incision and an endoscope (an instrument that contains a small camera) or with a traditional open incision
Complications of surgery – complications are associated with surgery. The most common complications of surgery include incomplete relief in pain and nerve damage.
Recovery rate from surgery – Though many patients have good results from surgery but it is less recommended as the surgery can result in chronic pain and nerve damage. It is recommended only when all nonsurgical treatments got failed at least for one year.
In nutshell Plantar Fascia is caused by tear or rupture in plantar fascia due to heavy strain on it. The strain could come from overrun, wearing uncomfortable shoes with sole or any heel injury. The most recommended treatment includes physical stretch therapies, taking rest as much as you can, Orthotics Therapy, massage therapy, Extracorporeal shock-wave Therapy (ESWT) or surgery in worst cases.
For temporary relief from mild pain any anti-inflammatory medicine like ibrufen can be taken. If the pain goes severe, your doctor may suggest you to take some asteroid.