What is Plantar Fasciitis?

What is Plantar Fasciitis?

The plantar fascia is a thick layer of connective tissue that starts from the heel and continues to the underside of each toe. It provides support to the arch of the foot and serves as a shock absorber during activities that require extension of the toes (e.g., running, walking).

Plantar fasciitis, according to Harvard Medical School, is a painful inflammation of the plantar fascia caused by drastic or sudden increases in use, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, resulting in heel pain. Plantar fasciitis occurs when this band of tissue is overloaded or overstretched, causing small tears in the fibers of the fascia, especially where the fascia meets the heel bone.

Plantar Fasciitis

Source: Harvard Medical School

How widespread is Plantar Fasciitis?

According to the study, about 10% of the United States population experiences bouts of heel pain, which results in 1 million visits per year to medical professionals for treatment of plantar fasciitis. The annual cost of treatment for plantar fasciitis is estimated to be between $192 and $376 million dollars.

Plantar fasciitis is most common between the ages of 40 and 60. However, it is also observed in younger people who spend more time on their feet, like athletes or soldiers.

What are the symptoms?

Plantar fasciitis symptoms can occur either gradually or suddenly. When they happen suddenly, they are felt during the first steps in the morning (called first-step pain). The symptoms can also appear as a sharp stab or deep ache in the middle of the heel or along the arch of the foot. That kind of pain usually disappears when walking around, but it may return later that day.

When the condition appears gradually, the heel pain lasts longer. This condition will cause you to shorten your running or walking distance. You may also start shifting your body weight towards the front of the foot, away from the heel.

What causes this problem?

Plantar fasciitis is associated with a lack of flexibility of the calf muscles and Achilles tendon as well as high-arched feet. This condition can be triggered by physical activities that overstretch the fascia, including intense sports training, running a long distance too fast and too soon, neglecting to stretch the calf muscles or just a change in running surface.

It can also be caused by other activities like household tasks, increased hill work, and worn shoes. Even new, but poorly constructed, shoes with minimal heel cushioning and insufficient arch support or sole heel flexibility can contribute to the problem.

Prevention

You can prevent plantar fasciitis by maintaining a healthy weight and by performing stretch and warm-up exercises before running or starting any sports activity. Stretching the plantar fascia in the morning before getting out of bed is recommended. It is also important to select shoes with good arch support and heel cushioning. Changing shoes to a new pair every 250-500 miles (400-800 km) is suggested as well. Constantly switching between two pairs of shoes seems to help some people, as the time period when the shoes are not used helps them to recover their cushioning to the effective level.

People who already have had plantar fasciitis could prevent it from returning by performing exercises that stretch the heel cord (also known as Achilles tendon) and plantar fascia.

After stressful athletic activities, an ice massage on the bottom of the foot could also prevent the condition. Runners who have plantar fasciitis may need to temporarily decrease their running. After a recovery period, activities may be resumed at their previous level of activity. However, before doing so, patients should consult with a physical therapist.

Treatment

First of all, if you have significant foot or heel pain (especially if this pain makes it difficult for you to walk normally), call your doctor immediately. The first step in treatment of the condition is massaging your feet by rolling a golf or tennis ball under your foot. Then you need to apply ice by rolling a frozen bottle of water under your foot. After that first aid, it is crucial that you use proper footwear. Having proper arch support is very important; avoid walking around barefoot or in a flimsy shoe as this can delay recovery time. Most patients with plantar fasciitis recover with conservative treatments (including resting, icing the painful area, and stretching) after several months.

If this conservative treatment does not help, the doctor may recommend that you wear a night splint for 6 to 8 weeks. During sleep, the night splint keeps the patient’s foot in a neutral or slightly bent position to help maintain the natural stretch of the plantar fascia and heel cord. If the night splint does not work, the next treatment option may be to inject corticosteroid medication into the painful area or place your foot in a short leg cast for one to three months.

Plantar fasciitis patients may also be treated with shockwave therapy, in which the focused sound energy is applied to the sore heel. The shockwaves then irritate or injure the plantar fascia to encourage healing. However, according to Harvard Medical School, the overall benefit of this approach is uncertain.

If all the above listed methods fail, then the doctor may suggest plantar fascia surgery. However, this method is rarely used, and surgery is not always successful in eliminating the plantar fasciitis condition.

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