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What is plantar fasciitis? Treatment: physical therapy, surgery, symptoms, and more…


What is plantar fasciitis?

What is plantar fasciitis? 

Plantar fasciitis is one of the most prevalent orthopedic complaints and is characterized by pain at the bottom of the foot, around the arch and heel. 

What are the causes of plantar fasciitis?

The plantar fascia is a web-like, thick ligament that connects your heel to the front of your foot. The function of this ligament is to absorb stress and support the arch of your foot when walking. The ligament is subjected to wear and strain regularly. When too much strain is applied on your foot, it might cause the ligament to injure or rupture, resulting in heel discomfort and stiffness.

Research conducted in 2003 showed that the illness may be caused by degeneration rather than inflammation of the plantar fascia. [1]

Plantar fasciitis is most common in active men and women between the ages of 40 and 70. It is also somewhat more prevalent in women than in males. Pregnant women frequently suffer from plantar fasciitis, especially in late pregnancy.

Other risk factors for the development of plantar fasciitis include foot arch problems, obesity, and sudden weight gain. It is also more common in people that wear shoes without arch support.

Symptoms of plantar fasciitis

People suffering from plantar fasciitis usually complain of discomfort at the bottom of the heel or, in some cases, at the bottom of the mid-foot. This condition normally only affects one foot but can affect both.

Plantar fasciitis pain increases progressively over time. The discomfort might be subtle or acute. Some persons have a burning or aching sensation on the sole of their foot, radiating outward from the heel.

The discomfort is frequently worst in the morning when you take your first steps out of bed, or after sitting or sleeping down for a long time. Heel stiffness can make climbing the stairs quite difficult.

Treatment

Home therapies are very effective to treat plantar fasciitis and can include rest, ice, bracing, and anti-inflammatory medicines. If they don’t help, a corticosteroid injection straight into the injured part of the ligament may. This can be done by a specialist doctor.

An ultrasound scan may be used by your doctor to assist select the optimal location for the injection. Corticosteroids can also be applied to the skin of your heel or the arch of your foot, followed by a painless electrical current to allow the steroid to travel through your skin and into the muscle.

Physical therapy

Plantar fasciitis can be treated with physical therapy. It helps to stretch your plantar fascia and Achilles tendons. A physical therapist may offer you exercises to strengthen your lower leg muscles, which can help you walk more steadily and reduce the strain on your plantar fascia.

Shock wave therapy

If the pain persists and conventional treatments are ineffective, your doctor may consider extracorporeal shock wave therapy. In this therapy, sound waves are used to assault your heel to encourage ligament mending. This therapy may have the following side effects:

  1. Bruises
  2. Swelling  
  3. Pain
  4. Numbness

Stretching exercises

Stretching has been shown to strengthen the plantar fascia – this helps to prevent plantar fasciitis

This condition can be relieved and even prevented with gentle stretches. Stretching your calves and the plantar fascia can help to relax the muscle and alleviates heel discomfort.

It’s critical to rest from certain workouts, like jogging, to allow the plantar fascia to repair. Swimming and other low-impact exercises allow you to move without aggravating your heel discomfort. When you begin running again, do it carefully at first.

To keep the discomfort at bay, take breaks and stretch when exercising. Remember to stretch before starting your workouts as well.

Plantar fasciitis stretches are simple to do. You’ll just need a few simple props, such as a chair and a foam roller, or even a frozen water bottle.

Surgical treatment

The most radical treatment for chronic plantar fasciitis is surgery. This is only done if the pain is severe or lasts longer than 6 to 12 months.

Surgery can cause persistent pain and nerve damage, therefore it should be considered only after all other therapeutic options have been exhausted.

Gastrocnemius recession

If you have difficulty bending your feet despite constant stretching, your doctor may suggest gastrocnemius recession. Your calf muscles will be surgically lengthened to promote ankle mobility and flexibility in the foot and to relieve tension on the plantar fascia.

A study conducted in 2018 on 17 patients showed that this surgery improved foot function and decreased discomfort in those who are overweight or obese and have persistent plantar fasciitis. [2] However, more research is needed to help substantiate this claim.

Plantar fascia release

During a plantar fascia release, your surgeon will remove a portion of your plantar fascia ligament to reduce stress and, ideally, irritation. This might involve making tiny slits in the ligament or removing the plantar fascia from the heel bone. Endoscopic or open surgery might be used to complete the procedure.

This relieves stress but weakens the arch of the foot, and proper function may be compromised.

Self-care for plantar fasciitis

To minimize swelling, the first line of defense is to stay off your feet and apply ice for 15 to 20 minutes three or four times each day.

You might also experiment with lowering or altering your workout routine. Engaging in stretching exercises may also assist to alleviate pain.

Nonsteroidal anti-inflammatory medicines (NSAIDs) including ibuprofen (Motrin or Advil) and naproxen (Aleve) can help relieve ligament discomfort.

Support for plantar fasciitis

Arch supports – wearing arch support insoles for your shoes may help reduce some of the discomforts by absorbing pressure, and they may help prevent additional plantar fascia injury. Consider wearing running shoes that are designed to support the arch of your foot when going on runs.

Splints for sleeping – night splints are another therapy option that can help stretch your leg and arch. Night splints are a form of brace that maintains your foot flexed and lengthens the plantar fascia and Achilles tendon as you sleep. This can help to prevent morning stiffness and soreness.

Wearing a boot cast – while the plantar fascia recovers, a boot cast can immobilize your foot and relieve tension. For bathing, you may remove the boot cast, which resembles a ski boot.

FAQ

When should I see a doctor?

If you’ve done the early RICE (Rest, Ice, Compression, and Elevation) therapies and/or your pain isn’t responding to any of the plantar fasciitis remedies described above, you should look into alternative causes of heel pain. Seek medical attention as soon as possible so that you may obtain assistance in building a treatment plan and understanding the sources of your pain.

Can plantar fasciitis cause calf pain?

Can plantar fasciitis directly cause pain in the calf muscles? The short answer is no since the plantar fascia and the calf muscles are not directly attached. However, being unable to put pressure on the feet and walk, may lead to the muscles weakening, making them susceptible to sprains and muscle cramps which can lead to calf pain.

Can arthritis increase the risk of plantar fasciitis?

Rheumatoid arthritis is a chronic disorder that affects the joints, particularly the tiny joints in the foot. This disorder causes inflammation of the joints and surrounding tissues, which renders rheumatoid arthritis patients more susceptible to plantar fasciitis.

What are the pressure points for plantar fasciitis?

To put it simply, trigger points are sites throughout the body that, when correctly pressed, can cause changes in the body’s function. There are several trigger sites throughout the body. Those associated with plantar fasciitis discomfort often include:

  1. Plantaris 
  2. Quadratus Muscles
  3. Gastrocnemius
  4. Soleus

References

[1]: Plantar fasciitis: A degenerative process with no inflammation (2003) https://japmaonline.org/view/journals/apms/93/3/87507315-93-3-234.xml

[2]: Gastrocnemius recession for recalcitrant plantar fasciitis in overweight and obese patients (2018) https://pubmed.ncbi.nlm.nih.gov/29409193/

Resources

This training course by Podiatrist Steve Bailey contains useful information on how to manage and treat plantar fasciitis effectively.

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