What is plantar fasciitis? Symptoms, prevention, and treatment
Plantar fasciitis affects one in ten adults in their lifetime. The plantar fascia is a thick tissue that connects the ball of the foot to the heel and also supports the arch of the foot. When this muscle becomes strained or compressed, severe pain can result and become chronic. Heels can actually develop new bone and create painful heel spurs—bony projections that cause intense pain. This chronic pain condition can impact life every day, and if left untreated can become severe and require surgery.
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Major plantar fasciitis symptoms are:
- Stiffness or soreness in the whole foot, especially in the morning
- Swelling and redness
- Pain in the heel and the arch
- Flat feet or high arches
- Burning or tenderness in the soles of the feet
- Difficulty going up or down stairs
Left untreated, the heels can develop painful bony spurs, a growth of bone in the heel that presses painfully into the soles.
What are major plantar fasciitis causes?
Plantar fasciitis is caused mainly by one or more of the following:
- Poorly fitting or unsupportive footwear
- Excessive exercise on hard surfaces
- Improper or non-existent warm-up
- Not enough rest of the feet
The leading cause of plantar fasciitis is stress or strain on the plantar fascia that causes tiny tears in the ligament. These tears cause inflammation and pain, which makes walking or other activities difficult, especially in the morning. Not warming up or using proper conditioning techniques are other causes of plantar fasciitis, as is starting a new physical activity after long periods of rest or inactivity. These activities may cause microscopic tears that are only found once a diagnosis of plantar fasciitis is made.
People with very flat feet or very high arches are prone to plantar fasciitis due to the shortening or lengthening of the tissue and the strain that causes.
For athletes, training repetitively on hard surfaces with improper footwear can cause plantar fasciitis. A rapid increase in the intensity of a workout, or the length of a workout can also trigger painful symptoms. Some patients report that symptoms worsen over time, but others say that their symptoms occurred suddenly.
Men between the ages of 40 and 70 are most likely to experience the pain of plantar fasciitis, but people of all ages can develop this condition. Some behaviors can increase the risk. A genetic history or family record of plantar fasciitis is a primary risk, as is simply getting older.
Although everyone who walks on the planet is capable of developing plantar fasciitis, there are a few specific risk factors that can increase your chances of developing it.
Increased weight means increased daily pressure on the feet. This additional daily strain can cause all kinds of problem in the lower extremities, including swelling and pain in the feet.
Those with first-degree relatives (parents or siblings) who develop plantar fasciitis are more likely to develop the condition themselves.
A person with liver disease, diabetes, or thyroid issues may have issues with their circulatory systems that put them at risk for plantar fasciitis. These metabolic conditions may result in not enough blood and oxygen to the feet, which can cause pain in the plantar fascia.
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Smokers and those who have a history of overuse of alcohol may be more at risk for developing plantar fasciitis. This may be closely linked to inactivity, and obesity may be a contributing factor as well.
Getting older is a primary risk factor for plantar fasciitis. Men between 40 and 70 years of age are the demographic most likely to be diagnosed with this condition.
Many of these risk factors deal with metabolic issues and may be related to the circulation of blood in the feet. There are some physicians who believe that this condition is a result of high acidity in the body, and they point to the variety of those affected as proof. Patients with plantar fasciitis can be marathon runners or couch potatoes. They can be in good health otherwise or be obese with an unhealthy diet. There are multiple risk factors that have not been explored deeply at this point, but there are also a variety of treatment options.
How is this condition diagnosed?
Physicians diagnose plantar fasciitis with a combination of patient interviews and examination. Doctors will especially focus on onset and any activities that may have caused the pain.
If bone spurs are suspected, doctors may order X-rays to confirm that diagnosis.
How to prevent plantar fasciitis
Prevention is key for this condition. Patient education can help with this. Some of the best ways to prevent this condition include:
- Finding proper footwear
- Utilizing orthotics when needed
- Properly warming up
To prevent plantar fasciitis, a warm-up is essential. Beyond shoes, many athletes ignore their feet when they begin to workout. Here are a few stretches that can be done to get the blood flowing in the feet before beginning.
- With feet bare, grasp toes with one hand and the heel with the other. Bend the toes back with one hand as the other hand pulls the heel back. Hold for 30 seconds.
- Still with bare feet, start in a squat with your toes spread wide. Lean forward slowly and bring your knees to the ground so that your toes are still flexed underneath you. Sit back on your heels as far as you can. This is a very intense stretch, so go slowly and back off if it becomes painful. Hold for at least one minute.
- Place hands on a wall, shoulder height. Step the left foot straight back so there is about two or three feet between your left toe and right heel. Move your hips forward, keeping your left heel down, until you feel a stretch in the calf. Don’t bounce, just hold for 30 seconds. Release, and do the same with the right foot.
You can also use a tennis ball to massage the arch of your foot. Add pressure as you can, but go slowly. This should relieve pressure and feel good. You can roll the tennis ball all over the foot, putting weight onto it to increase the depth of massage. If you need a deeper massage, switch to a harder ball with less “give.”
How do you treat plantar fasciitis?
The initial treatment options are easy to comply with and generally non-invasive. A period of rest and icing to the affected area can help with pain and inflammation, as can over-the-counter non-steroidal anti-inflammatory drugs (nsaids). If the plantar fasciitis is due to injury or repetitive motion, then rest is essential, with as little strain put on the foot as possible.
Depending on the extent of your pain, you may also need to try some other treatment options. These are discussed below.
For severe cases, doctors may recommend a boot or other immobilizing support, but in milder cases, shoes with orthotic insoles or firm arch support will be adequate.
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Patients will be instructed on specific stretches and movements to loosen and condition the plantar fascia. Plantar stretches may include placing the foot on the opposite knee while seated and flexing the feet strongly while pulling back on the toes.
While working the plantar fascia like a muscle may seem odd, new research has found that doing so can actually improve recovery times. A recent study published in the Scandinavian Journal of Medicine and Science in Sports found that plantar fascia has a job that is similar to the Achilles tendon in both load bearing and function. Researchers studied the effect of this specific tendon in a randomized group of 48 patients with plantar fasciitis. They wanted to see if high-load strength training, typically utilized to develop muscles and stretch tendons in the lower leg, would offer superior results to traditional plantar stretches.
One study group completed plantar stretches ten times for ten seconds, three times per day, and the other group completed unilateral heel raises using a towel under the toes. Study participants stood on a raised platform and placed their toes on a rolled-up towel. Patients took three seconds to raise up on tiptoe, paused for two seconds, then took three seconds to slowly lower down. Patients performed the activity with one foot at a time, starting with three sets of 12 repetitions. They gradually added weight by filling a backpack with books. The repetitions were decreased but the number of sets was increased as weight was added to the backpack.
The result? The high-load strength-training group achieved short-term pain relief more quickly than the group that completed traditional plantar fasciitis stretches. While both groups had similar levels of pain at the six and 12-month mark, the pain-relieving effects of high-load strength training were immediate.
Research presented at the Society of Interventional Radiology’s Annual Scientific Meeting has indicated that ultrasound imaging and targeted ultrasonic energy is an effective way to not only break up and remove tissue damaged by plantar fasciitis but to also allow healthy tissue to regenerate in its place. One hundred patients treated with this therapy starting in 2013 have reported positive, long-lasting relief.
Rahul Razdan, M.D., one of the study’s researchers and an interventional radiologist at Advanced Medical Imaging in Lincoln, Nebraska, noted that this is the first treatment option that goes beyond short-term solutions:
“While standard treatments, such as pain medication and physical therapy, can offer some relief, there have been no permanent answers. It is important for patients suffering from chronic plantar fasciitis to know that they have treatment options. We have patients who are in so much pain they can’t even play with their kids or take their dog for a walk. This ultrasonic treatment can give patients their lives back and let them enjoy their lives.”
For inflammation that persists, doctors may prescribe corticosteroids for short periods of time. If pain persists, and a cast or a boot does not help with the pain and inflammation, then doctors may prescribe steroid injections. For the most severe cases that are not responding to treatments, doctors may try plantar fascia release where they cut into the connective tissue to ease the tension and stress that is causing the pain.
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