Plantar Fasciitis

It’s easy to take for granted how essential your feet are for everyday tasks. Each foot bears the weight of yourbody when walking or running. As such, the muscles and connective tissues in the feet are subject to a large amount of stress. The feet are designed to absorb this stress with an intricate system of muscles, ligaments, tendons,and padding. It’s no wonder that your feet are particularly susceptible to injury, regardless of your athletic ability

Foot pain is a common medical issue. Many adults suffer from substantial heel pain caused by plantar fasciitis. The plantar fascia is a ligament that runs from the back of the heel, through the length of the foot, and connects at the base of each individual toe. This tissue can become damaged for a variety of reasons, resulting in microtears, inflammation, and (potentially) scar tissue. Injuries to this area often elicit pain and/or stiffness in your heel.

Heel pain is typically focused on the interior side (the same side as your big toe). Pain is described as stabbing or sharp and is most noticeable when patients first step out of bed in the morning. While this pain will often dull over the course of the day, it will return when stepping on the foot once again after a period of rest. Most patients experience pain that is contained to the back of the foot, although some have pain that radiates from the heel and towards the toes.

Symptoms of plantar fasciitis are similar to several other conditions that affect the foot including various types of arthritis, heel spurs, bone fractures, and tendonitis, among others. Since each condition is caused by a different mechanism (and thus the treatment is different), it’s necessary to diagnose the correct condition to remedy the pain.

Foot Anatomy

The plantar fascia is a thick band of connective tissue that runs from the back of the heel, along the length of the foot, and attaches to the toes. Seeing as it runs along the bottom of the foot, it is heavily affected by other structures within the foot, ankle, and leg that help maintain proper alignment and walking patterns.

The arch of the foot refers to its curve. Arches allow for proper support and foot propulsion (pushing forward) when walking or running. If you have arches that are too low (often referred to as flat-footed)or too high (often referred to as an over arch), increased stress can make your plantar fascia more vulnerable to injury.

The Achilles tendon connects the heel to the calf muscle and runs along the back of the ankle. If the Achilles tendon is too tight, it can lead to extra stress around the heel when walking. This, in turn, contributes to more stress on the plantar fascia, increasing the chances of injury.

The way you walk is called your gait. This includes what part of your foot makes contact with the ground, the manner in which your foot rolls along the ground, and how you push off the ground with each step. Maintaining proper gait is important as even a slight variation inward or outward results in increased rotation of the plantar fascia with each step. This also increases the likelihood of injury.

Risks and Causes of Plantar Fasciitis

There is currently no identified cause of plantar fasciitis. Its name suggests that pain is due to inflammation, which does occur due to microtears. However, current research now suggests that the condition is more likely due to degeneration of the tissue and not merely inflammation.

As with many injuries to muscles and their corresponding connective tissues, this damage can occur due to either acute trauma or chronic, repetitive use. Acute injuries result from sudden, high impact events. This can occur due to sudden impact or as a result of high-stress twisting or stretching of the ligament in an unnatural motion, such as unintentionally rolling your foot in an awkward motion. More often than not, plantar fasciitis is due to chronic stress on the ligament. This regularly results from overstretching of the ligament or repetitive impact over an extended period of time. Pain associated with chronic use will occurwithout a specific injury event.

The feet are meant to bear the weight of our bodies since humansare meant to walk upright.Our feet have a variety of cushioning features that allow for shock absorption. However, any additional weight gain will applymore force to the feet. People that are overweight or obese are therefore more at risk of developing plantar fasciitis. Pregnant women are also at risk, as they will gain additional weight over the course of their pregnancy. It’s not uncommon for a pregnant woman to develop plantar fasciitis, especially in the third trimester, when they may have issues standing on their feet for extended periods of time.

Athletes, especially those that participate in running sports, are also more likely to experience plantar fasciitis. Long distance runners, in particular, often have issues due to chronic use or overuse, due to the amount of time spent running.

Those people that work in environments that involve long periods of standing on their feet have an increased risk as well.

Plantar Fasciitis Diagnosis

Many people, especially those that have experienced plantar fasciitis previously, may recognize the familiar pain associated with the condition. The most common symptom is a sharp pain that is most intense in the morning when first stepping out of bed. However, there are additional foot issues that cause pain and, if left untreated, can develop into more complex issues. For this reason, pain that lasts for more than a few days should be assessed by a professional.

For most cases of plantar fasciitis, a primary care provider is sufficient to make a diagnosis and prescribe proper treatment. Your doctor will use a methodical assessment. In this they will try to determine:

• Where the pain is located or starting from
• When is the pain is most intense
• Was this the result of an acute or chronic injury
• Determine if specific motions cause the pain

It’s likely they will push on different areas of the foot searching for areas of sensitivity or possible swelling. They will also need a detailed history that includes your occupation, physical activity level, and any past injuries to your leg/ankle/foot. Often, providers will ask that you manipulate your foot in a variety of ways (pointing your toes, flexing your foot up, rotating in circles, walking on your tip toes, etc.) as each motion utilizes a different set of muscles and connective tissues.

Lab testsdo not offer any real insight or help in diagnosing plantar fasciitis. Imaging techniques are limited but may allow your provider to rule out other similarly presenting conditions. Depending on your pain level, your doctor may order an X-ray or MRI to rule out more serious bone or muscle issues.

Plantar Fasciitis Treatment Options

Treatment options for plantar fasciitis run the spectrum from conservative to very invasive. The best treatment option is dependent on the patient and should take into account the intensity of pain, specific type of injury, any previous injury, other conditions that may contribute to issues in the future, and response to previous therapies. The good news is that most cases can be treated with relatively conservative approaches. For particularly mild cases, rest, elevation and ice are sufficient.

If medication is necessary for short term pain relief there are several over-the-counter anti-inflammatory options. These include ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin (Excedrin). Non-steroidal anti-inflammatory drugs (NSAIDs) coupled with short term rest and temperature relief (such as an ice pack and/or heating pad) are the first tier approach when attempting to heal from plantar fasciitis.

Specific stretching, massage, and limited physical therapy sessions are also useful treatment options. Gentle stretching allows you to move your foot to experience the correct range of motion, without weight bearing stress. Massaging the affected area should increase blood flow and aid in healing tissue damage and breaking up scar tissue.

When conservative therapies fail to adequately address heal pain, the next level of treatment involves steroid injections, night splints,or shock wave therapy. Steroid injections involve shots in the foot that directly address pain and swelling. These shots are often effective for several months at a time. Night splints are physical braces that are placed on the affected foot every night before going to sleep. The splints hold the foot in a position (toes up) that creates a continuous, passive stretch of the plantar fascia throughout the night. Extracorporeal shock wave therapy (EWST) uses sound waves to target the damaged area and promote healing.

A large majority of patients will find relief and recover with one or more of the previously discussed options. For the minority of patients that still suffer from heel pain after a year, a more invasive procedure may be necessary. A Tenex procedure involves using an ultrasound image, a small cut near the affected area, and removal of damaged tissue that is causing pain. As a last resort, a more intensive surgery can be performed to release the plantar fascia from the heel.

Once you recover from plantar fasciitis, it’s common to incorporate practices to prevent another injury. This is accomplished with proper stretching, along with sufficiently supportive shoes. Additional support can come from insoles for your shoes or taping if you’re participating in athletics. It may also be beneficial to continue applying ice and/or heat and massage as needed.

Treatment options for shoulder pain is best achieved through a combination of injection in conjunction with graded rehabilitative exercise.  Individual programs may include a cortisone shot, regenerative medicine, PRP injection, PRP treatment or stem cell therapy which boosts the body’s natural ability to heal.

If your pain does not resolve after a brief period, contact us. so that we may help diagnose the problem and treat the underlying cause.  Do not let pain persist or else it may become chronic.