Plantar fasciitis

Plantar fasciitis

Plantar fasciitis is a common injury affecting a person’s heel. The plantar fascia (a thick band of connective tissue that runs from the heel bone to the toes on the underside of the foot) is responsible for supporting the arch of the foot and when load or tension becomes too great on the fascia, tears can develop. Repeated tears will result in an inflammatory response. The main symptoms include a stabbing pain and irritation/inflammation of the plantar fascia. The pain is usually evident immediately in the morning once weight has been taken through the foot and will usually subside as the day progresses and the fascia loosens up. Standing or being in a seated position for a prolonged period might also set the pain response off again.

Plantar fasciitis can be easily diagnosed by a medical professional and usually a patient history and examination will be sufficient to make the diagnosis.

There are certain factors that make people more prone to developing plantar fasciitis. They are:

• Age: It is more prevalent with people between the ages of 40 to 60.
• Obesity: Extra weight carried is transferred through the fascia causing more load and increasing one’s disposition to plantar fasciitis.
• Lifestyle factors: People who have to stand on their feet for most of the day (especially on hard surfaces) are also at increased risk.
• Certain exercise: High stress activities on the plantar fascia, such as long distance running and dancing, can also contribute to an inflammatory response.
• Incorrect foot biomechanics: Whether the foot has a longitudinal arch or a high arch, or even if an abnormal gait is evident, these factors will result in an uneven load being placed through the fascia and thereby more stress through it. This is even more important to recognise as people with incorrect mechanics will develop a compensatory walking gait which will ultimately affect the stability of the ankle, knee and hip joints.

In most cases, conservative treatment modalities will be sufficient to allow the inflammation to settle within a few months. These modalities include the following:

• Physiotherapy: Correct lengthening and strengthening exercise prescription will offload the load on the plantar fascia and stabilize the ankle and foot. Correct foot biomechanics can also be taught to prevent recurrence of the condition.
• Splints: Foot splints worn at night time have been proven to be very effective in treating plantar fasciitis. The splint holds the fascia (and your calf muscle) in a lengthened state while you sleep thereby decreasing the stress experienced and facilitates a quicker recovery.
• Orthotics: They can also be prescribed to help with foot mechanics to correct any imbalances in the load distribution of the foot.

Simple ‘do-at-home’ tips will also help to alleviate the pain experienced. They include:

1. Losing weight to reduce load on the fascia.
2. Choose correct shoes which have sufficient support and shock-absorption. High heels and barefoot (especially on hard surfaces) should be avoided at all costs! Also, worn out shoes (especially running shoes) is a big factor so shoes should be changed before they lose their supportive functionality.
3. Choose a different sport if the one you do has a high impact component.
4. Apply the RICE principle especially the ice aspect. 15-20min of ice will result in a significant reduction of pain albeit it temporary till the inflammation settles.
5. Stretches for the calf, Achilles and plantar fascia will help. It is important to note thought that you do the correct stretches and that you don’t overstretch

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If these conservative modalities aren’t working, more intrusive treatments could be recommended by your medical professional. They could include:

• Steroid injections
• Extracorporeal shockwave therapy
• Plantar fascial surgery

As mentioned before, these should be seen as a last resort only once non-invasive treatment plans have been proven not to work.