About 2 million Americans are treated for plantar fasciitis every year. A familiar explanation for heel pain in adults, it impacts almost one in every 10 people. Traced to structural changes in the underside of the foot, this painful disorder is common among athletes, seniors, and those impacted by obesity.

What is Plantar Fasciitis?

Plantar fasciitis refers to pain in the heel linked to structural changes, inflammation, injury, or scarring in the plantar fascia, a thick tissue that “connects heel bone to toes” spanning as the bottom arch of the foot.

When this connective tissue becomes swollen, inflamed, or weak, one feels hurting pain in the heel or sole of the foot. It creates sharp pain in the morning when you wake up forcing you to limp out for the first few steps. But as you walk for a while, the plantar fascia slackens off and the pain moderates. However, the stabbing pain recurs when you get up from a prolonged sitting position or remain in a standing position for long. Even the same painful condition persists if the ligament is not used or stretched for a long time.

What causes Plantar Fasciitis?

When plantar fascia is strained or racked, plantar fasciitis hurts your foot. Repeated stress and tension make the ligament weak, torn, inflamed, and possibly injured leading to swelling and pain as you walk or stand.

Plantar fascia’s primary role of a shock-absorbing ligament helps sustain the arch underside the foot. It may sprain or develop tiny tears in the face of frequent overwhelming stress. Frequent small tears cause structural breakdown of the thick band of tissue. As a result, this thick band of tissue becomes inflamed and patients feel pain at the point it connects to the heel bone.

Recent studies indicate “degeneration of the tendon fibers close to the attachment to the heel bone” as a possible cause of plantar fasciitis. Athletes commonly face this painful disorder. Their tight calf muscles overstretch and strain the plantar fascia as they regularly perform in high-velocity activities involving the foot for longer periods. Frequent overstretching thickens connecting tendons and the plantar fascia loosens snapping its strength and flexibility. As result, heel pain starts whenever the fascia comes under pressure to expand.

According to the Journal of the American Academy of Orthopedic Surgeons, troubled collagen fibers and calcium deposits constricting tissues may also result in plantar fasciitis.

The following conditions also contribute to plantar fasciitis.

• Walking style or twisting exerting too much pressure on the plantar fascia
• Running or walking in footwear unable to offer comfortable cushioning and adequate arch support
•  Excessive weight gain that causes pressure on the foot arch during walking or standing
• Degenerative structural changes in the plantar fascia
• Disturbed digitorum brevis muscle in the foot
• Achilles tendons
• Injury to the foot.

What are the symptoms of Plantar Fasciitis?

Plantar fasciitis is associated with sharp pain and stiffness in the heel. It gets worse in the morning forcing you to limp out for a few meters. The stabbing pain returns when you stand or keep your foot inactive for a long period or get up from a prolonged sitting position. Stretching the foot or climbing stairs may result in pain. The pain may gradually spread to other parts of the foot and make you feel tenderness, swelling, and redness underside your foot.

Who is at risk of Plantar Fasciitis?

Plantar fasciitis occurs in middle-aged people. The nature of foot use makes runners, athletes, dancers, and soldiers more prone to the pain. Overweight men and women are also at the greater risk of developing it.

How is Plantar Fasciitis diagnosed?

Assessment of age, risk factors, and symptoms help doctors zero on the potential disorder. Physical examination of the foot assists in identifying tenderness of the heel bone, tendon tightness, and stretching pain. X-rays of the pain area help detect bone spurs, thickening of tissue and inflammation associated with plantar fasciitis.

What are the treatment methods available for plantar fasciitis?

• Medications

Patients are prescribed NSAIDS, ibuprofen, or naproxen pain relievers (pills or cream) to reduce inflammation and pain caused by the disorder. However, medications may fail to subdue plantar fasciitis pain older than six to eight weeks.

• Surgical Intervention

Rarely used to treat plantar fasciitis pain, surgery removes the heel spur or disengages the plantar fascia ligament from the heel. However, surgery is resorted only when there is acute pain and no other treatment option is available. Disconnecting the fascia from the heel also undermines the foot arch and loosens nerves.

• Orthotics and Night Splints

Patients use heel cups or cushioned arch support to ensure that there is no stressful pressure or strain that may worsen plantar fasciitis pain. Splints prevent stiffening of the thick ligament-like tissue and tendons and keep them elongated overnight so that there will not be pain when they are stretched in the morning. However, these aids work only for patients of mild or the beginning phase of the disorder.

• Non-Operative Pain Management
• PRP Injections: Platelet rich plasma is obtained from the bone marrow of the patient and injected to the plantar fascia. This works as a regenerative medication and creates cells that replace degenerative tissues prone to plantar fasciitis pain. The therapy has no major side effect, as it empowers and facilitates natural healing process in the human body.
• Steroid Shots: Steroid injections ensure semi-permanent pain relief that lasts up to a few weeks. However, taking these injections too often may weaken the heel bone.
• Botox Injections: According to the Foot & Ankle International journal, scholars at Mexico’s Nuevo Leon University have discovered usefulness of Botox injections for treating plantar fasciitis pain.
• Extracorporeal Shock Wave Therapy: Sound waves are administered to the plantar fasciitis pain area in your heel. The therapy energizes the healing process, but with the risk of pain, bruises, and inconsistent pain relief result.

References

American Association of Orthopedic Surgeons

Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW (June 2014). "Plantar and Medial Heel Pain: Diagnosis and Management". The Journal of the American Academy of Orthopaedic Surgeons 22 (6): 372–80

Wapner KL, Parekh SG. Heel pain. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine.3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009

Raymond R. Monto, Platelet-rich Plasma and Plantar Fasciitis, Sports Medicine and Arthroscopy Review, Volume 21, Number 4, December 2013;220–224

Jorge Elizondo-Rodriguez, et al; A Comparison of Botulinum Toxin A and Intralesional Steroids for the Treatment of Plantar Fasciitis: A Randomized, DoubleBlinded Study; Foot & Ankle International, 34(1) 8–14

Fran Lowry, Botox Injections Relieve Pain of Plantar Fasciitis, Across Specialties, Skin & ALLERGY NEWS, May 2008

Jeswani T, Morlese J, McNally EG (September 2009). "Getting to the heel of the problem: plantar fascia lesions". Clin Radiol 64 (9): 931–9