What is Plantar Fasciitis?
The plantar fascia is a tough, fibrous band of tissue that runs from the base of the heel to the ball of the foot. It functions like a rubber band that creates tension and provides support to the arch of the foot. Plantar fasciitis occurs because of repetitive overstretching of the plantar fascia. As the tissue overstretches and contracts, tiny tears occur in the fascia leading to pain and inflammation. These small tears most commonly occur at the bottom of the heel where the fascia attaches to the bone. As the condition progresses, the fascia thickens and becomes less elastic. This causes the fascia to become even more susceptible to repeated micro-tearing, making it difficult for the tissue to fully heal.
What are the symptoms of plantar fasciitis?
The most common symptom of plantar fasciitis is pain in the bottom of the heel, especially with the first few steps out of bed in the morning. Patients also report that the pain decreases as they move around but returns after they've rested for some time than stand up again. Other patients, however, will experience increased pain with prolonged standing or exercise. The longer they're on their feet, the worse the pain becomes. In more severe cases, the pain is the worst at the end of the day. Even though the pain is most commonly felt on the bottom of the heel, symptoms can occur anywhere along the course of the fascia, which extends through the arch to the ball of the foot.
What are risk factors for plantar fasciitis?
· Jobs or activities that involve standing or walking for extended periods of time, especially on hard surfaces
· Excessively high or low arches
· Wearing inappropriate or unsupportive shoe gear
· Obesity
· Excessively tight posterior muscle groups (calf and hamstring)
· Biomechanical abnormalities, such as excessive pronation
· Rapid transition from sedentary lifestyle to regular exercise
How is plantar fasciitis diagnosed?
Plantar fasciitis is a diagnosed primarily based on the patient's medical history and a physical examination. Onbrexamination, pressure is placed over the course of the plantar fascia, and the most tender spot is usually at the bottom of the heel. The pain may be exacerbated by forcing the toes upward toward the patient's leg, or by having the patient stand on the tips of their toes. Swelling is often noted in the inner arch near the heel. Your doctor may order x-rays to view the heel bone to rule out other conditions such as a fracture, or to evaluate for the presence of a heel spur. A heel spur is a bony projection coming from the bottom of the heel where the fascia inserts. It should be noted that a heel spur is rarely the source of heel pain. The pain is most often caused by inflammation of the fascia near the spur. An in-office ultrasound may also be used to look for abnormal thickening of the fascia. In cases when the condition doesn't improve with conservative treatment, an MRI might also be considered.
How is plantar fasciitis treated?
The objective of treating plantar fasciitis is to reduce pain and inflammation. Common treatments include:
· Supportive shoe gear
· Avoiding barefoot walking and flats
· Custom orthotics or quality over the counter inserts to improve faulty biomechanics
· Restrict activities that caused the condition
· NSAID's
· Icing
· Stretching and strengthening exercises
· Cortisone injections
· Physical therapy
· Use of a night splint or Strassburg sock (device that is worn on the foot to keep soft tissues stretched while sleeping)
· brEPAT or Shockwave therapy
· brSurgery is occasionally indicated when all conservative treatments have failed
Plantar fasciitis can be extremely painful and can hamper your ability to work and enjoy recreational activities. You should seek treatment from a foot and ankle specialist at the earliest onset of symptoms so that you can get better faster. At FAANT we have a team of skilled physicians who treat plantar fasciitis daily and are sympathetic to how impactful this condition can be on the everyday lives our patients – stop in and see us!
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