Plantar Fasciitis: Symptoms, Causes, and Treatments

What is plantar fasciitis?

Plantar fasciitis is a prevalent and frequently distressing foot ailment impacting a significant global population. The demographic primarily affected by this condition comprises active adults aged between 25 and 65 years.

The onset of plantar fasciitis transpires when the plantar fascia, a fibrous tissue band beneath the foot responsible for arch support, undergoes excessive strain or stretching. Overuse or prolonged stress leads to a reduction in the fascia’s elasticity and resilience, ultimately causing inflammation and resultant pain.

What are the symptoms of plantar fasciitis?

Plantar fasciitis symptoms may manifest gradually or suddenly, especially following intense physical activity. Early recognition of these symptoms is crucial for timely intervention and effective management.

It is essential to acknowledge that the manifestation and persistence of symptoms can vary among individuals. The key symptoms of plantar fasciitis encompass:

1. Pain on the underside of the foot, near the heel: This is the foremost and characteristic indication of plantar fasciitis. The pain can range from a persistent ache to a sharp, stabbing sensation. Concurrently, the arch along the bottom of the foot may experience aching or a burning sensation.

2. Intense heel or foot discomfort upon morning awakening or after prolonged periods of rest: This pain typically diminishes after a few minutes of walking.

3. Exacerbation of heel or foot pain following physical activity: Although not commonly experienced during exercise, activities such as climbing stairs can intensify the pain.

4. Tenderness when palpating the affected area, particularly near the heel: Sensitivity to touch is a notable symptom.

5. Foot stiffness, particularly upon waking up or after extended periods of sitting: This stiffness can impede comfortable walking.

Understanding and identifying these symptoms are fundamental for seeking appropriate medical attention and adopting effective strategies for managing plantar fasciitis.

What causes plantar fasciitis?

Plantar fasciitis arises when the thick band of tissue on the underside of the foot (known as the fascia) undergoes excessive stretching or strain, typically resulting from repetitive stress associated with activities such as prolonged standing or running. Notably, significant weight gain, as seen during pregnancy, can also contribute to its onset.

The continuous stretching and strain on the plantar fascia may lead to chronic degeneration, marked by the formation of small tears in the fascial fibers, especially at the point where the fascia attaches to the heel bone. Ultrasound assessments frequently reveal not only these tears but also calcifications and thickening of the plantar fascia.

Several risk factors heighten the susceptibility to plantar fasciitis, including:

1. Foot arch issues: Both flat feet and high arches can increase the likelihood of developing plantar fasciitis.

2. Engaging in long-distance or downhill running on uneven surfaces: Such activities contribute to the repetitive stress that can trigger plantar fasciitis.

3. Excessive body weight: Carrying extra weight, including during pregnancy, places additional strain on the plantar fascia.

4. Tight Achilles tendon: A lack of flexibility in the Achilles tendon can contribute to the development of plantar fasciitis.

5. Wearing shoes lacking proper arch support or with soft soles: Inadequate footwear can exacerbate the strain on the plantar fascia.

6. Abrupt changes in activity levels: Sudden increases in physical activity, especially those involving the feet, can heighten the risk of developing plantar fasciitis.

Plantar fasciitis diagnosis

If you suspect the presence of plantar fasciitis or are enduring persistent foot pain, seeking professional medical attention is imperative for an accurate diagnosis and the formulation of an effective treatment plan. Early intervention and proper management can significantly alleviate symptoms and enhance your overall quality of life.

During your consultation, your doctor will conduct a thorough examination of your foot, specifically observing for the following signs or risk factors associated with plantar fasciitis:

1. Maximum tenderness on the bottom of your foot, just ahead of the heel bone: This localized tenderness is a key indicator.

2. Foot arch abnormalities: High arches or flat feet are recognized risk factors for plantar fasciitis.

3. Restricted dorsiflexion (upward motion) in your ankle: Limited movement in this direction may be noted during the examination.

4. Exclusion of symptoms associated with other foot conditions that share similarities with plantar fasciitis: This involves distinguishing symptoms from conditions like insertional Achilles tendinitis, calcaneal (heel) stress fracture, or plantar nerve entrapment.

In addition to the physical examination, your doctor may opt for diagnostic imaging such as x-rays or ultrasound evaluations, especially if the history or physical examination hints at other potential injuries or conditions like heel spurs, fractures, or arthritis. Ultrasound can reveal thickening and swelling of the plantar fascia, a characteristic feature of plantar fasciitis.

In cases where initial treatments prove ineffective or if your doctor harbors concerns about an alternative source of your pain, further diagnostic tools such as magnetic resonance imaging (MRI) or additional ultrasound may be considered to provide a more comprehensive understanding of the underlying issue.

How to treat plantar fasciitis

The majority of individuals with plantar fasciitis observe improvement within nine to 12 months through nonsurgical treatment methods. Common treatments for plantar fasciitis encompass:

1. Rest: Taking a break from activities that exacerbate pain is the initial step. This allows the plantar fascia to heal. During this period, low-impact exercises like cycling or swimming can be considered.

2. Ice: Applying ice to the affected area helps reduce inflammation and alleviate pain. Rolling the foot over a cold water bottle or using an ice pack for 15 to 20 minutes several times a day, especially after pain-triggering activities, is recommended.

3. Stretching: Targeted stretching exercises help alleviate plantar fasciitis by lengthening tight muscles in the feet and calves, reducing tension on the plantar fascia.

4. Night Splints: Devices worn during sleep, night splints stretch the plantar fascia to prevent overnight tightening, reducing morning pain and stiffness.

5. Supportive Shoes: Wearing shoes with proper support and cushioning is crucial. If pain persists, custom-made shoe inserts (orthotics) may be recommended.

6. Physical Therapy: A physical therapist may devise an exercise program focusing on calf muscle and plantar fascia stretching. Specialized ice treatments, massage, and other therapies may be included to reduce inflammation.

7. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs, such as ibuprofen, can reduce pain and inflammation, but should be used under healthcare guidance and for a limited duration.

If the pain persists, additional measures may be considered:

• Walking Boot and Crutches: Temporary use to allow foot rest.
• Corticosteroid Injections: For severe pain and inflammation, though limited due to potential side effects.
• Extracorporeal Shockwave Therapy (ESWT): Noninvasive high-energy shockwaves to promote healing, with varying efficacy.
• Botulinum Toxin Injections: Used to relax tissues around the plantar fascia, providing relief.
• Dry Needling: Controversial technique using sterile needles to stimulate trigger points.
• Laser Therapy: Low-level laser therapy to reduce pain and inflammation, with varying results.
• Foot Surgery: Considered in cases where nonsurgical treatments do not yield improvement.

Surgery for plantar fasciitis

Surgery for plantar fasciitis is typically considered a last resort, given that over 90% of patients recover with nonsurgical treatments. While many patients achieve positive outcomes with surgery, it is not without risks and can lead to chronic pain and dissatisfaction.

Two common surgical procedures for plantar fasciitis are:

1. Gastrocnemius Recession: This procedure involves a small incision on the inside of the calf (gastrocnemius), where the calf muscles are lengthened using a specialized instrument. The surgery aims to enhance ankle flexibility, thereby reducing tension on the plantar fascia. While there is a potential for nerve damage and calf weakness, the associated risks are generally low.

2. Partial Plantar Fascia Release: This surgery entails making an incision on the bottom or side of the heel to alleviate tension in the plantar fascia. The most prevalent complications of release surgery include the risk of nerve damage.

What are the best shoes for plantar fasciitis?

Selecting the right shoes is paramount for individuals with plantar fasciitis, as proper footwear plays a crucial role in reducing the risk of developing or exacerbating the condition. Consider the following key features when choosing shoes for plantar fasciitis:

1. Arch Support: Opt for shoes with proper arch support to distribute pressure evenly across the foot, thereby reducing strain on the plantar fascia.

2. Cushioning: Choose shoes with ample cushioning in the heel and forefoot to absorb shock and diminish impact on the plantar fascia.

3. Heel Support: Look for shoes with a firm heel counter (the back part that surrounds the heel). A firm heel counter helps counteract tension placed on the fascia during heel strikes, minimizing microtrauma. Soft silicone heel pads can also be beneficial by elevating and cushioning the heel.

4. Shock Absorption: Prioritize shoes with effective shock absorption properties, especially in the heel area. Features like cushioned soles or gel inserts can aid in absorbing shock.

It is advisable to consult with a podiatrist or orthopedic specialist for personalized recommendations based on your foot structure and the severity of your plantar fasciitis. Additionally, off-the-shelf or custom-fitted arch supports, known as orthotics, can assist in evenly distributing pressure on your feet, offering further support and comfort.

Stretching exercises for plantar fasciitis

Studies indeed support the efficacy of plantar fascia-specific stretching as part of the treatment for plantar fasciitis. One study demonstrated a 52% improvement in heel pain after eight weeks of dedicated plantar fascia stretching. Additionally, maintaining flexibility in the calf muscles is crucial for preventing plantar fasciitis. Incorporating these stretches into your daily routine, three times a day (morning, midday, and before bed), can be beneficial:

1. Calf Stretch:

• Lean forward against a wall with one knee straight and the heel on the ground.
• Place the other leg in front with the knee bent.
• Push your hips toward the wall, feeling a pull in the calf during the stretch.
• Hold the position for 15 to 30 seconds.
• Repeat the stretch for both legs.

2. Plantar Fascia Stretch:

• Sit in a chair with one foot on the floor.
• Raise the other leg and rest the ankle on your knee in a figure-4 position.
• Grasp the toes of your raised foot with your hand.
• Gently pull your toes back until you feel a stretch in the sole of your foot.
• Simultaneously, gently massage the stretched plantar fascia with your other hand.
• Hold this position for 10 seconds.
• Repeat the stretch 10 times on each foot.

These stretches, when performed regularly, can contribute to the relief and prevention of plantar fasciitis symptoms. If you have any concerns or questions about incorporating these stretches into your routine, consulting with a healthcare professional is advisable.