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About Plantar fasciitis
The plantar fascia is a thick band of tissue that stretches from the heel to the toes. Plantar fasciitis occurs when this tissue becomes inflamed, causing pain at the bottom of the heel. According to the American Academy of Orthopedic Surgeons, around 2 million people are treated for plantar fasciitis every year. Common symptoms of an inflamed plantar fascia include:
- Stabbing pain in the bottom of the foot, near the heel
- Pain in the arch of the foot
- Sharp pain after exercise
- Increased pain in the morning, or after long periods of standing
The plantar fascia is meant to absorb the shocks and strains put on the foot. When too much pressure or tension is applied to the ligament, small tears start to develop. Over time, these small tears lead to inflammation and pain in the foot.
There is no common cause of plantar fasciitis, but there are several factors that can put you at greater risk of damaging your plantar fascia. You are more at risk of developing plantar fasciitis if:
- You are an athlete. Runners, ballet dancers, and jumpers put a lot of pressure on their feet, increasing their risk of plantar fasciitis.
- You are on your feet for long periods. Occupations that require you to be on your feet for long stretches of the day (teachers and factory workers, for instance) place you at greater risk of developing plantar fasciitis.
- You have high arches or flat feet. Different foot mechanics can place different amounts of stress on your foot. Individuals with flat feet or high arches can put increased tension on the plantar fascia.
- You are obese. If you are overweight, you are putting extra pressure on your plantar fascia. 70% of people who see a doctor for plantar fasciitis are obese.
If left untreated, the pain caused by plantar fasciitis can interfere with your everyday life. However, nearly all patients who seek treatment for plantar fasciitis see improvement within several weeks after starting therapy.
Most cases of plantar fasciitis can be treated with self-care remedies. Below is a list of treatment options that can help relieve pain and heal the affected area. During your appointment, talk to your provider about the treatment plan that’s right for you.
Where does plantar fasciitis cause pain?
Plantar fasciitis causes pain at the bottom of your foot. Most people with plantar fasciitis experience pain in their heel or along the arch of their foot. This pain can be sharp or dull. For some, plantar fasciitis feels like a knife; for others, it feels more like a bruise. In some cases, plantar fasciitis can interfere with nerves in your foot and ankle, causing further discomfort.
How is plantar fasciitis diagnosed?
Your doctor may be able to diagnose you with plantar fasciitis based on your description of symptoms alone. This can be done during video or in-person visits. If you’re seeing a doctor in person, the doctor will examine the structure of your foot and may take a further look at the wear of your shoes. If your feet roll inwards when you walk or run - known as pronation - you'll likely have more wear on the inner side of the shoe. If your feet roll outwards, or supinate, you’ll likely have more wear on the outer side of the shoe. This information can help doctors determine if your plantar fasciitis is being caused by an irregularity in the way that you walk.
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How is plantar fasciitis treated?
There are a number of ways to treat plantar fasciitis - including both at-home remedies and medical procedures. Common treatments include:
Rest: Sometimes, staying off your feet for a few days can be the best medicine.
Ice: Ice the bottom of your foot for 15 minutes using a cloth-covered ice pack 4 to 5 times a day.
Physical therapy: Physical therapists can provide you with exercises to help stretch the plantar fascia and Achilles tendon and strengthen your calf muscles. These exercises will help support your ankles and the arch of your foot. Your physical therapist may also show you the correct way to apply kinesthetic tape to your foot, which can help provide much-needed support.
Medication: Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen may help reduce discomfort, pain, and inflammation.
Shoe supports: Orthotics like arch supports or other shoe inserts are a way to better distribute your weight across your foot while providing extra comfort. This can help take pressure off of the plantar fascia.
Night splints: Your physical therapist may recommend the use of night splints which help stretch the affected area while you sleep by keeping your foot at a 90-degree angle.
Your doctor may recommend x-rays, MRIs, or other procedures if your plantar fasciitis has not responded to previous treatments. Some of these procedures include:
Injections: Steroids such as cortisone, or platelet-rich plasma from the patient. Speak to your healthcare provider to determine whether or not a corticosteroid injection would be beneficial to your recovery.
Extracorporeal shock wave therapy: A therapy that sends sound waves through the area that is affected to prompt healing.
Ultrasonic tissue repair: A procedure in which a probe is inserted into the damaged part of the fascia using the assistance of ultrasound imaging. Once inserted, the tip of the probe vibrates, breaking up the damaged tissue and suctions the broken tissue out.
Surgery: While rare, surgery is sometimes needed to detach the plantar fascia from the heel bone, also known as the calcaneus. Your doctor would recommend you to an orthopedic surgeon to perform the surgery. The calcaneal procedure can be done under local anesthesia or as an open procedure.
What is the main cause of plantar fasciitis?
The cause of plantar fasciitis differs from person to person and isn’t always clear. Sometimes plantar fasciitis can develop with no clear cause.
Your plantar fascia looks like the string of a bow. That bow acts as a shock absorber that can sometimes become inflamed. The inflammation is caused by tiny tears in the fascia which may be due to overstretching and/or overuse.
Plantar fasciitis is common in distance runners. Running long distances puts pressure on the plantar fascia, especially if your shoes are worn out or lack proper support, and can lead to inflammation.
Who is at higher risk of plantar fasciitis?
Some risk factors for developing plantar fasciitis include:
Age: The most common age group to suffer from plantar fasciitis are those between the ages of 40 and 60.
Certain types of exercise: The repetitive shock to your heel and fascia during activities such as ballet, long-distance running, and aerobics can cause stress and tears to the fascia.
Foot mechanics: Sometimes having flat feet, also known as pes planus, or high arches, or a particular pattern of walking can leave you at higher risk for getting plantar fasciitis.
Obesity: Weight can put stress on your arches.
Active Employment: Teachers, factory workers, grocery clerks, farmers, construction workers, delivery workers, and many other individuals with active jobs are at greater risk of developing plantar fasciitis. These professions often demand employees spend hours on their feet - often for long periods of time on hard surfaces. This can cause damage to the fascia and lead to chronic plantar fasciitis.
How long does plantar fasciitis last?
What can I do to prevent plantar fasciitis?
There are a few things you can do in order to prevent plantar fasciitis. These include:
Maintaining healthy body weight: Weight-bearing on the medial arch stretches the fascia. The more weight, the more it stretches.
Wearing good shoes with good support: Avoid high heels if you can. Wear proper athletic shoes. When these shoes begin to wear, doctors recommend you purchase new shoes with adequate support and cushioning.
Avoiding activities that have a high impact on the feet: Running, ballet, and other strenuous, high-impact activities can place undue stress on the plantar fascia and lead to fasciitis.
Applying ice: Sometimes, applying ice to the bottom of your foot can help reduce swelling and inflammation and keep fasciitis at bay.
Stretching your legs and feet: Stretching exercises include targeting the Achilles tendon, calf muscles, also called gastrocnemius, and your plantar fascia.
How does the way I’m walking impact my plantar fasciitis?
Irregular walking patterns are a common cause of plantar fasciitis. The Mayo Clinic suggests that walking barefoot can be hard on the foot arch. Wearing supportive shoes with proper inserts recommended by your podiatrist can help reduce your chances of plantar fasciitis.
Some jobs require a lot of walking. Proper walking techniques and stretching exercises can help minimize your risk of developing plantar fasciitis.
How do I know if I have plantar fasciitis or heel spurs?
Bone spurs, or more specifically, heel spurs, are growths on your heel bone that can be a result of plantar fasciitis. It is even possible to have bone spurs and not know it. They occur in more than half of the people who suffer from plantar fasciitis. A doctor might recommend x-rays if you are concerned about heel spurs.
What activities are limited by plantar fasciitis?
High-impact activities such as running, jumping, ballet, or aerobic dance can aggravate plantar fasciitis. If you're suffering from plantar fasciitis, your doctor may recommend you participate in low-impact activities, like bicycling or swimming, instead of running.
Do massages help with plantar fasciitis?
Foot massage may help with the affected areas. Please note - self-massages should never be painful. It’s recommended that you start softly, avoiding any very sensitive spots.
Though massages may be helpful to some, they may not help all. More clinical studies are needed to compare treatments for plantar fasciitis. However, in a randomized clinical trial, the study found that plantar fasciitis improved with the combined efforts of stretching and deep calf massages.