Overview
Plantar fasciitis is an inflammation caused by repetitive microtears to the plantar fascia, a thick band of tissue running across the bottom of the foot. This condition is one of the most common causes of heel pain in adults.
What is the Plantar Fascia?
The plantar fascia starts at the heel bone (calcaneus) and extends towards the toes, providing crucial support for the foot arch. It absorbs shock and aids in lifting the foot during walking. When repetitive stress leads to collagen degeneration and inflammation in this area, the condition is referred to as plantar fasciitis.
Causes of Plantar Fasciitis
Structural abnormalities like flat feet (pes planus) or high arches (cavus foot) increase the risk of developing plantar fasciitis. Other contributing factors include leg length discrepancies, muscle tightness, or overuse of the foot through activities like long-distance running or jumping. Obesity, prolonged standing, wearing unsupportive footwear, and the use of high heels also play a role in triggering this condition. Additionally, people with diabetes or arthritis are more prone to developing plantar fasciitis.
Risk Factors Related to Footwear and Activity
Sudden increases in physical activity, such as marathon running, or performing high-impact sports on hard surfaces can cause undue strain on the plantar fascia. Unsupportive shoes, especially those with inadequate cushioning or high heels, exacerbate this problem.
Symptoms
The hallmark symptom is severe heel pain, especially with the first steps in the morning. Most individuals feel pain at the inner part of the heel, which can worsen when pressing on the area. While pain may decrease with activity, it often returns after long periods of standing or at the end of the day. In advanced cases, stiffness and persistent discomfort may occur throughout the day.
Diagnosis
A physical exam is the primary method of diagnosing plantar fasciitis. Tenderness in the heel area, especially along the medial calcaneal tuberosity, is a key indicator. Tests, such as stretching the toes or observing how the patient stands on their tiptoes, can help confirm the diagnosis. Imaging tests like X-rays or MRIs are typically only necessary if symptoms don’t improve with initial treatments or if another diagnosis is suspected.
Treatment
Conservative Treatments
The first line of treatment involves addressing the underlying causes and implementing the following strategies:
1. Correcting footwear and exercise habits: Avoid improper exercise techniques and opt for supportive shoes.
2. Stretching exercises: Regularly stretching the plantar fascia and Achilles tendon is crucial. One effective method involves pulling the toes back while sitting, holding the position for 15-20 seconds. This stretch should be performed several times daily, especially in the morning or after sitting for extended periods.
3. Heel cups: Devices like heel cups can provide cushioning and reduce heel impact. They are available in both rubber and hard plastic forms, the latter offering better shock absorption.
4. Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are helpful during acute flare-ups but should not be used long-term due to potential side effects.
5. Corticosteroid injections: For severe cases, steroid injections may be considered, but these carry the risk of complications like fascia rupture or fat pad atrophy.
Surgical Options
If conservative treatments fail after six months or more, surgery to release the plantar fascia may be considered. This can be performed using minimally invasive techniques, such as arthroscopy, but should be approached with caution due to risks like nerve damage. Success rates for surgery range between 70-90%, depending on the case.
Prognosis and Complications
Plantar fasciitis generally improves over time without invasive treatments, but recovery can take 6-18 months. While complications are rare, untreated plantar fasciitis can lead to altered gait, affecting the knees, hips, and lower back.
Prevention
Maintaining a healthy weight and avoiding excessive strain on the feet are crucial preventive measures. Choose shoes with adequate cushioning and support, and avoid activities that put unnecessary pressure on the plantar fascia. Early intervention and consistent treatment improve recovery outcomes, and most patients respond well to conservative therapies.
Home Care and Diet
Lifestyle changes such as proper footwear, stretching, and resting the feet are key to managing and preventing plantar fasciitis. Applying ice to the affected area can reduce inflammation. It's also important to avoid prolonged standing and high-impact sports during recovery.
0 Comments