Plantar Fasciitis

Everything you wanted to know about Heel Pain (Plantar Fasciitis)

Millions of individuals are affected by heel pain. The disorder, otherwise known as plantar fasciitis can be quite disabling and restricts lifestyle. In general, the pain in plantar fasciitis is burning in nature and worse in the morning or after rest. The moment the individual puts the foot down on the floor upon awakening, he/she may feel sharp burning pain in the heel area. In rare cases, one may find that even putting on shoes is painful. Once the individual starts to become mobile during the day, the pain does decrease slightly. However, there are times when heel pain may become worse after prolonged standing or seating. Plantar fasciitis is most common in the 4th -6th decade of life and occurs in athletes, obese individuals, and pregnant females.

What is the function of the plantar fascia?

The plantar fascia is a strong piece of tissue that connects heel bones to the arch of foot. The fascia acts like a shock absorber and provides a cushioning effect against trauma to the sole. When the plantar fascia is exposed to excessive tension or repeated trauma, it develops minute tears which results in heel pain.

What are common causes of plantar fasciitis?

Physical activity is a common cause of plantar fasciitis. The disorder is quite common in athletes especially individuals who jog or run long distances. The constant pounding on the heel tends to cause tears in the fascia. Other sporting activities known to induce stress on plantar fascia include prolonged standing, jumping activities and bodybuilding.

Anatomical derangements such as a flat foot or a high arch can also led to development of plantar fasciitis. Some individuals may have had injury to the heel or bottom of the foot and also develop plantar fasciitis later in life.

One common cause of plantar fasciitis is wearing ill-fitting or tight shoes. Women who wear high heel shoes with poor lateral and arch support are prone to plantar fasciitis.

Individuals who develop arthritis of the knee or hip are also quite prone to plantar fasciitis. It appears that the plantar fascia also gets inflamed in arthritis.

Some diabetics do develop moderate to severe degree of plantar fasciitis. It is believed that in some cases the heel pain may be related to nerve damage. Pain control in diabetics can also be quite difficult.

How is plantar fasciitis diagnosed?

Most individuals attempt homemade therapies first before going to see a health care professional. For this reason the diagnosis of plantar fasciitis is always delayed. The diagnosis of plantar fasciitis can be easily made from a history and physical exam. No fancy radiological tests are required except for a foot x-ray that may sometimes reveal a bone spur.

How is plantar fasciitis treated?

The treatment of plantar fasciitis is primarily conservative. In the majority of cases, supportive care is more than adequate for most people. In many cases the symptoms do subside over time. Present supportive care treatment include custom made arch supports, use of night splints and physical therapy.  Physiotherapist may also include soft tissue work, exercise program, education about self management strategies and foot mobilization.  While these treatments do reduce pain, most individuals also require use of pain medications. When there is little response to pain medications, one may require use of corticosteroid injections. Unfortunately, response to corticosteroids is not always consistent nor does it work in all individuals. Other therapies for plantar fasciitis include ultrasound guided massages. Both these treatments have been used to treat resistant cases of plantar fasciitis. Ultrasound guided massages tend to work well when the pain is acute. However, multiple sessions are required.

In some cases, surgery may be an option but is limited. Surgery is never the first choice and one should always seek a second opinion prior to undergoing surgery. Results of surgery are poor.

The best way to treat plantar fasciitis is to prevent it in the first place. To avoid developing plantar fasciitis, one should wear decent shoes with good arch and lateral support, maintain a healthy weight, and warm up prior to any exercise.

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