Care For Tendons

Plantar Fasciitis

Illustration of Plantar Fasciitis, a condition characterized by degeneration of the plantar fascia, leading to heel pain

What Causes Plantar Fasciitis?

Plantar fasciitis is a common foot condition that causes heel pain, particularly in the morning or after periods of rest. While often referred to as "plantar fasciitis," it`s more accurately classified as a form of tendinopathy due to the fact that the plantar fascia is a tough structure at the sole of the foot and resembles tendons. This is also a continuity of the Achilles tendon beyond the heel into the bottom of the foot. Like tendons, this structure may be affected by degenerative processes leading to small minute tears, disorganization of fibers, and inflammation - due to continuous and repetitive use of the plantar fascia. Like in other tendinopathies, repetitive actions often lead to such conditions. Similarly, the plantar fascia, being a tendinous structure in the sole of the feet that maintains the arch of the foot and leads to a springing action when required, may be subjected to degenerative processes. Plantar fascia connects your heel bone to your toes, passing across the sole of the foot. The reason this condition is classified as a form of tendinopathy is that structurally this fascia resembles any tendon. Degeneration, likewise, would lead to similar changes in the plantar fascia, like collagen breakdown and changes in the matrix, causing pain, and degeneration often and sometimes swelling.

Factors that can contribute to its development include:

  • Overuse: Activities that put excessive stress on your feet, like running or jumping, standing for a prolonged period can increase your risk.
  • Foot Structure: Flat feet or high arches can alter the way your foot absorbs impact, making you more susceptible.
  • Imbalanced Weight Distribution: Some people develop these diseases when, due to any reason, the weight of the body is transmitted to one heel mostly, sparing the other.
  • Tight Calf Muscles: Tightness in your calf muscles can put added strain on the plantar fascia.
  • Improper Footwear: Like wearing high heels.
  • Obesity: Excess weight places additional stress on your feet.
  • Age: The plantar fascia tends to become less flexible with age, making it more prone to injury.
  • Achilles Tendinopathy: If you have Achilles tendinopathy, you may quite commonly develop Plantar fasciitis.

How do I know that I have plantar fasciitis?

The most common symptom of plantar fasciitis is heel pain, often described as a sharp, stabbing sensation while standing or walking, meaning while putting pressure on the heel. This pain is typically worse in the morning or after periods of inactivity and may improve with movement. You might also experience tenderness or stiffness in your heel. The best way to detect plantar fasciitis is to consult an Orthopaedic surgeon.

Common signs include:

  • Pain and stiffness along the plantar fascia, especially in the morning or after periods of rest.
  • Swelling or thickening of the plantar fascia that can be felt by the doctor.
  • Pain on touch.
  • Reduced movement range in the ankle.

How Does the Doctor Treat Plantar Fasciitis?

If you suspect you have plantar fasciitis, it`s important to consult an Orthopaedic surgeon. Your doctor can only diagnose and treat this accurately. They will likely examine your foot, assess your gait and movement in the ankle, and may recommend imaging tests like X-rays or ultrasounds to rule out other conditions.

Treatment for plantar fasciitis focuses on reducing pain and inflammation while promoting healing. Common approaches include:

  • Rest and activity modification: Reducing or altering activities that do not hurt the plantar fascia is crucial for initial pain relief.
  • Ice and heat therapy: Applying ice packs to the affected area can help reduce inflammation, while heat therapy can improve blood flow and promote healing.
  • Stretching and strengthening exercises: Specific exercises targeting the calf muscles, Achilles tendon in the back of the heel, and plantar fascia can improve flexibility and strength, supporting recovery.
  • Physical Therapy: A physical therapist under guidance of Orthopaedic surgeon can design a personalized program including various modalities like ultrasound, massage, and exercises to accelerate healing and prevent the problem from coming back.
  • Orthotics (supporting things) and footwear: Proper footwear and orthotics can help fix movement problems that cause Plantar fasciitis.
  • Medications: Your doctor may suggest management using a regenerative approach for managing Plantar Fasciitis and sometimes add-on over-the-counter pain relievers to help manage pain.
  • Injections: Sometimes, in advanced cases, your doctor may decide to inject corticosteroids or PRP (platelet-rich plasma) within the Plantar fascia.
  • Surgery: In some cases, when usual treatments fail, the doctor may suggest or perform a surgery to release the Plantar fascia.

Prevention is Key

You can prevent the pain & discomfort due to plantar fasciitis by:

  • Maintaining a healthy weight: Excess weight puts extra stress on your feet.
  • Wearing supportive shoes: Choose shoes with good arch support and cushioning.
  • Gradually & regularly increasing activities: Stretch your calf muscles and plantar fascia daily.
  • Proper warm-up and cool-down routines.
  • Cross-training: Vary your activities to avoid overuse of specific muscles and tendons.
  • Nutritional Management: Sometimes, the doctor may suggest nutritional products to maintain healthy Plantar fascia and to prevent degeneration.

References

[1] Mayo Clinic. (2023). Plantar fasciitis. Link
[2] National Institutes of Health (NIH). (2021). Plantar fasciitis.
[3] National Health Service (NHS). (2022). Plantar fasciitis. Link