What is Plantar Fasciitis?
The plantar fascia is a band of tissue on the sole of the foot that supports the arch of the feet. It runs from your heel to your toes and functions as a shock absorber when we move.
Plantar fasciitis is one of the most common causes of heel pain caused by inflammation of your plantar fascia.
How do I know if I have plantar fasciitis?
- Stabbing pain in the bottom of your foot near the heel
- Pain is usually the most intense in the morning when you take your first step out of bed, then the pain decreases over the course of the day
- It can also be triggered by long periods of standing or when you get up after prolonged sitting
- Pain typically occurs just after activity/exercise
What are the causes of plantar fasciitis?
Who is at risk of getting plantar fasciitis?
Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:
- Age. Plantar fasciitis is most common between the ages of 40 and 60.
- Certain types of exercise that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis.
- Foot mechanics. Flat feet, a high arch or even an abnormal pattern of walking can affect the way weight is distributed when you are standing and can put added stress on the plantar fascia. Wearing shoes with soft soles and poor arch support can also result in plantar fasciitis.
- Excess weight puts extra stress on your plantar fascia, such as women who are in their late pregnancy or those who are overweight/obese.
- Occupations that keep you on your feet such as factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces may damage the plantar fascia.
How is plantar fasciitis diagnosed and investigated?
A typical history of heel pain that is worse in the morning which gets better with stretching and walking is often enough for your doctor to diagnose plantar fasciitis. Imaging such as X-rays or MRI scans are usually not necessary, unless your doctor would like to exclude other conditions such as a stress fracture.
X-rays may show a bone spur in the heel and there is often a misconception that it is the spur that causes the pain. There are lots of people with bone spurs who do not have any heel pain in the community.
What can happen if plantar fasciitis is left untreated?
Neglected plantar fasciitis may result in chronic heel pain that hinders your regular activities and affects the way you walk. Compensatory walking patterns may then lead to other joint problems such as knee, hip, or back pain.
Treatment options for plantar fasciitis
Initial self-care with ‘RICE’ (rest, ice, compression and elevation) and anti-inflammatory medication (Ibuprofen or Arcoxia) are often effective ways to treat plantar fasciitis. Regular stretching of your calf, hamstring and foot are crucial to relieve the symptoms.
Night splints work by holding the plantar fascia and Achilles’ tendon in lengthened positions overnight, promoting stretching. This helps to prevent morning heel pain.
Other ways to reduce the pain of plantar fasciitis include the following:
Maintain a healthy weight to reduce stress on your plantar fascia.
Choose supportive shoes with good arch supports and cushions. Do not wear worn out shoes with poor arch supports.
Stretch the arches of your foot.
Consider changing to a low impact sport such as cycling and swimming instead of running or jogging.
Procedures to treat Plantar Fasciitis
Physiotherapy is key in treating plantar fasciitis. It can help to stretch your plantar fascia and Achilles’ tendons. A physiotherapist can demonstrate some exercises to strengthen your lower leg muscles, helping to stabilize your walk and lessen the workload on your plantar fascia.
If conservative measures prove to be ineffective after several months of treatment, injections have been shown to alleviate symptoms and improve functions. These include a combination of a local anaesthetic and small dose of steroids, or platelet-rich plasma (PRP). Your orthopaedic surgeon may use an ultrasound device to help determine the best place for the injection.
Extracorporeal shockwave therapy (ESWT)
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment modality which directs soundwaves to affected areas to stimulate healing. ESWT has been shown to be effective in chronic cases of plantar fasciitis.
Surgery is often the last resort for chronic plantar fasciitis which has failed to respond to other forms of treatment. During a plantar fascia release, your surgeon partially detaches the plantar fascia from the heel bone either as an open procedure or through a small incision. If your surgeon finds your calf or gastrocnemius muscles tight and contributing to your plantar fasciitis, he may recommend gastrocnemius recession. This procedure involves lengthening the calf muscle to increase ankle motion and release stress on the plantar fascia.
Can Plantar fasciitis go away on its own?
Most plantar fasciitis patients improve with non-surgical treatments such as RICE, taking non-steroidal anti-inflammatory drugs (NSAIDs) and doing stretching exercises. It is also important to identify aggravating factors such as increased weight, tight muscles and ill-fitting footwear.
Is walking good for plantar fasciitis?
Repetitive motion from running can damage or tear the plantar fascia, causing inflammation and pain. Instead, grab a chair and do some simple stretching exercises that will help to relieve plantar fasciitis. Remember to sit up straight while you do them.
1. While seated, roll your foot back and forth over a frozen water bottle, ice-cold can, or foam roller. Do this for one minute and then switch to the other foot.
2. Next, cross one leg over the other for the big toe stretch. Grab your big toe, pull it gently toward you, and hold for 15 to 30 seconds. Do this three times, then reverse and do the same with the other foot.
3. For the third seated exercise, fold a towel lengthwise to make an exercise strap. Sit down and place the folded towel under the arches of both feet. Grab the ends of the towel with both hands, and gently pull the tops of your feet toward you. Hold for 15 to 30 seconds and repeat three times.
Why is my plantar fasciitis getting worse?
Aggravating factors such as increased weight, tight muscles, or ill-fitting footwear can contribute to the pain you are experiencing. Seek professional medical help if the pain persists despite conventional treatments such as RICE or exercises.
Does foot brace help plantar fasciitis?
Splints are a type of brace that holds your foot in a flexed position and lengthens the plantar fascia and Achilles’ tendon. You are encouraged to use it overnight as this can prevent morning pain and stiffness.
Special orthotics, or arch supports, for your shoes may help alleviate some of the pain by distributing pressure, and they can prevent further damage to the plantar fascia.