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Plantar fasciitis

Plantar fasciitis

This is a common and painful condition of the foot that affects many people.The problem comes about due to inflammation and thickening of the plantar fascia of the foot. This is a band of tissue that runs on the lower side of the foot from the front to the back.

Symptoms of plantar fasciitis

Most of the symptoms are in the foot and they include:

  • Sharp foot pain close to the heel
  • Pain worse on waking up – referred to as ‘first step pain’
  • Foot joints stiffness
  • Pain that improves with exercises but returns after the exercises
  • Pain triggered by walking for long
  • Limiting foot pain on standing up after prolonged sitting.

Causes and risk factors

The exact cause of plantar fasciitis is not well understood. Some experts theorize that repeated small injuries lead to the thickening and inflammation of the fibrous tissue of the plantar fascia. There are however, situations and conditions that increase the risk of developing this condition. They include:

Anatomical factors

This includes a short calf muscle that prevents the full flexion of the foot. The other problem here is an abnormally high arch of the foot. Flat footed people and those with other problems of the feet which affect their gait are also at an increased risk.

Lifestyle factors

This includes excessive body weight that creates too much strain on the foot. People who are mostly active on their feet, like athletes and soldiers, are also more likely to develop the problem. Changing from high heels to ordinary shoes suddenly can trigger the symptoms.

Ill-fitting and poorly padded shoes also increase the risk of plantar fasciitis.

Health conditions

Rheumatoid arthritis and other types of arthritis or inflammatory conditions such as systemic lupus erythematosus can increase chances of plantar fasciitis. Calcaneal spurs are common in people with this condition but they are not the cause. For this reason each of these conditions can be treated independent of the other.

Age

Plantar fasciitis is more common in those above middle age.

Injury may, but is rare, lead to the condition.

Diagnosis

The diagnosis can be made almost conclusively based on the clinical presentation. A thorough history about the pain and its association with time of waking up, exercises, occupation and type can all help in making an accurate diagnosis. Physical examination may reveal risk factors like obesity or anatomical foot problems.

Imaging investigations like X-rays and MRIs are not used routinely to diagnose plantar fasciitis. Instead, they are for ruling out other conditions of the foot.

Treatment

Treatment can be non-surgical or surgical. Majority of patients don’t need surgery. Non-surgical treatments include:

  • Analgesics
  • Corticosteroids
  • Physiotherapy.

Physiotherapy forms an import part of treatment. This alone can lead to many patients getting relief. Physiotherapy measures include:

  • Assisted exercises that stretch the calf muscles and the plantar fascia.
  • Use of special shoes and orthotics
  • Application of specialized ice or heat therapies.
  • Use of high energy Extra-corporeal shockwave therapy
  • Use of night splints

As a part of the treatment a physiotherapist educates the patient on how to take good care of their feet and how to prevent plantar fasciitis from getting complications or recurring in the future.

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