Plantar Fasciitis

What is Plantar Fasciitis?

In simple words, Plantar Fasciitis is the inflammation of the Plantar fascia, a thick bow of tissues supporting the arch of our foot. These tissues connect our heel bone (calcaneus) to our toes.  Normally, the Plantar fascia appears like a shock-absorbing bowstring which when subjected to larger stress, may start tearing. Repeated tension on these tissues leads to inflammation causing a stabbing pain in the feet. The pain may vary from slight discomfort to excessively high depending upon the degree of tissue rupture.

Causes of Plantar Fasciitis

This pain starts from under the heel and gradually spreads inward towards the foot arch. There may be some tenderness in the inner heel region, as the pain grows. The pain is usually sharp in the morning since our feet have remained relaxed for a long while, causing the plantar fascia to curve inwards and shorten.  On walking, the tendons stretch out causing a stabbing pain. It can also be triggered by long intervals of remaining sedentary or walking after exercise (not during).

This kind of inflammation is commonly categorized as an overuse injury where repeated stress and over-stretching of foot arch causes ruptures along the bow of tissues. The onset and severity of pain is likely to be more at the point where the tendons meet the heel bone (calcaneus), where the degeneration of tissue is more.

The presence of following risk factors add-on to the occurrence of this disorder:

• People aged between 40-60 have high chances of suffering from this pain.
• Sports and physical activities which are intensive, repetitive and stressful on the heels, such as aerobic dance, long-distance running, ballet dancing.
• A sudden change from a sedentary lifestyle to physically active lifestyle.
• Being flat-footed, having high foot-arch or even irregular way of walking can cause uneven weight distribution of body weight on our feet.
• Obesity can cause the Plantar fasciitis to strain and rupture more, especially when the weight gain is sudden and the feet haven’t gotten accustomed to the increased strain.
• Poor footwear, which has thin or worn out soles not providing enough cushioning to the feet.
• Pregnant women sometimes complain of this pain which surfaces in irregular bouts.
• Certain occupations which require one to be on feet such as factory worker, teacher, waiter etc increase your chances of developing this pain.
• Tight calf muscles which will further render the feet inflexible causing the plantar fascia to strain even more.

What are the symptoms of Plantar Fasciitis?

Those suffering from Plantar Fasciitis majorly complain of pain and a feeling of stiffness at the bottom of the heel. Some experience a pain in the middle region of the foot. A considerable tenderness is also felt in this region. This pain develops gradually and from only one foot. The degree of pain varies from person to person and depends upon the extent of rupture of the tendons. Some may encounter a dull pain while others feel a sharp throbbing pain which radiates along the entire foot.

Prolonged physical movements such as climbing stairs, excessive walking or running may cause the inflammation to flare up. In such cases, the plantar fasciitis pain is felt after the physical activity has ended.

How is Plantar Fasciitis diagnosed?

The most common indicators of Plantar Fasciitis are pain and tenderness in feet. The doctor will check for pain and tenderness in the feet in the exact locations as characterized by Plantar Fasciitis (usually 4cm inward from the heel). You may even be asked to flex and rotate your foot to determine the level of flexibility present. A dull redness and swelling may also be indicative of Plantar Fasciitis. Reflexes of the feet, co-ordination, and balance of the muscles are also checked before ruling out other foot-related issues.

An MRI or X-ray may be taken to make sure that the pain isn’t caused because of any other injury, bone spur, stress fracture or pinched nerve.

How to treat Plantar Fasciitis?

The most effective treatment includes combination approach of reducing the painful symptoms, stretching the calf muscles and lower leg muscles to facilitate a gradual healing.

• Reducing the pain: To reduce the inflammation the best technique is PRICE – Protection, Rest, Ice, Compression and Elevation.  Applying ice to the inflamed region for 10 minutes every hour for 24-48 hours relieves most of the pain. Here, the ice shouldn’t be applied directly to the skin, but in form of ice bags and cold packs.  One should avoid excessive physical activities, and try to keep feet elevated for most of the time when the pain is severe.

• Taping the feet: Binding the affected feet in soft cloth regularly, much of the strain of Plantar Fascia reduces causing the ruptures to heel faster.

• Night Splints and Arch Supports: Night splints, a type of foot brace, is quite effective in treating the inflammation as it holds the food in a flexed position, lengthening the Plantar Fascia in few hours. In addition to this, special orthotics or Arch Supports can be used to reduce the pain since they work by distributing the body weight evenly on the feet, thereby reducing the strain on the plantar fascia.

• Exercises: Stretching the calf muscles and plantar fascia is very important in regaining strength in these muscles after rupture. The plantar fascia is stretched by pulling the toes upward and stretching the foot arch. Rolling a ball under the feet also helps.

• Surgery: Even after continuous treatment, the pain doesn’t subside, the option remaining is surgery, however, the success rate remains between 70-80%.

How can one prevent Plantar Fasciitis?

• Increase physical activity gradually to prevent the onset of this pain.
• Wear correct footwear which provides enough cushioning to feet and don’t over-arch them.
• If you are an athlete, try getting regular sports massages.
• Apply ice to feet immediately after an intensive workout or prolonged sudden movement.
• Maintain a healthy weight and have normal walking patterns.
• Stretch feet before exercise, especially the Achilles tendon and plantar fascia

  
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