What is Plantar Fasciitis

Written by Carolina Vaccari

Plantar fasciitis is the most common cause of pain in the sole of the foot, commonly located around the heel and arch of the foot. In fact, plantar fasciitis is a result of there being inflammation of a connective tissue band, known as the plantar fascia, which stretches from the heel to the toes.

Overall, movements such as standing up for prolonged periods, standing up from sitting and rising the toes off the floor can all trigger the pain in the foot.

Plantar fasciitis can develop without an evident cause, but some factors can predispose an individual in suffering with plantar fasciitis. Risk factors include:

• Age: plantar fasciitis is more common in people between the ages of 40 and 60 years.
• Obesity: being overweight or obese puts extra weight and stress onto the plantar fascia. This is especially the case if there has been a sudden increase in weight gain.
• Posture and foot biomechanics: postural imbalances can affect the way weight is distributed between the two lower limbs and how you walk and stand up. As a consequence it can add more stress on the plantar fascia and cause an increase in irritation and inflammation to the plantar fascia. In addition, people with flat feet or a high plantar arch are more likely to develop plantar fasciitis because of the altered mechanics of the feet.
• Specific activities and occupations: people who spend most of their time at work walking or standing on hard surfaces are more prone to developing plantar fasciitis. For the same reason, runners or people who practice sports and activities which significantly involve the use of their feet (ballet dancer, gymnasts, football players) can increase the stress on the plantar fascia and develop the condition.
• Poorly fitted shoes: wearing shoes with poor cushioning or support may increase the risk of developing plantar fasciitis. Wearing high heel shoes also increases the likelihood of experiencing plantar fasciitis due to the uneven weight balance through the foot when wearing heels.
• Foot trauma: a previous history of foot or ankle trauma (e.g. ankle strain) that has not correctly healed may contribute to a change in the mechanics of the foot. Over time this may increase the risk of plantar fasciitis.

During the consultation a precise case history taking of your symptoms and thorough physical examination will be taken to help diagnose and understand the cause of your foot pain. The area of pain will be assessed and the practitioner will feel for any tenderness around the heel and the arch of the foot which trigger the symptomatology.

Usually further investigations are not necessary for diagnosing plantar fasciitis. However, in some cases investigations such as an X-ray or magnetic resonance imaging (MRI) may be required to rule out any other conditions (e.g. fracture) that can cause similar symptomatology.

One radiological sign connected to plantar fasciitis is the presence of a bony spur in the heel. This is a small piece of bone sticking out from the heel bone. However, bone spurs can be asymptomatic and detected in people who do not present with any pain around the heel.

Conservative therapy is considered the main treatment option for plantar fasciitis and it can help people to recover in several months.

Overall, resting, icing the painful area and wearing wide comfortable shoes with a low heel and soft sole are very beneficial for reducing the pain and helping aid recovery. Even though pain relievers may ease the pain and inflammation, manual therapy is usually suggested in order to aid in a faster recovery.

In some cases orthotics (e.g. soft insoles or heel pads) as well as night splints may be prescribed in order to:

• Increase the support to the plantar arch of the foot.
• Help to equally distribute the pressure to the feet.
• Stretch the Achilles tendon and plantar fascia.

In more severe cases or when conservative therapy is not consistently effective, other procedures might be recommended. They can include:

• Corticosteroid Injection: this is where steroid medication is injected into the tender area of the plantar fascia. It can provide temporary pain relief. Multiple corticosteroid injections of the plantar fascia is not recommended as it can weaken the connective tissue potentially leading to its rupture.
• Extracorporeal shock wave therapy: this procedure consists of directing sound waves to the affected area in order to stimulate its healing. It is usually used for chronic plantar fasciitis but evidence shows controversial results about its efficacy.
• Ultrasonic tissue repair: is a minimally invasive therapy which uses ultrasound to breakdown and remove damaged tissue within the plantar fascia.
• Surgical intervention: is usually a last response treatment. It is very rare for people to need surgery. The surgical procedure used consists of removing the plantar fascia from the heel. It is generally used when the pain is incredibly severe and other approaches have been ineffective.

Plantar fasciitis usually resolves within 6 to 18 months without treatment. With accurate precautions and consistent therapy the 95% of people with plantar fasciitis are able to recover within 6 months.

In order to help prevent plantar fasciitis from occurring there are few precautions you can take, these include:

• Avoid high impact activities: instead try to low impact exercises as this can help reduce stress to the plantar fascia.
• Weight loss: being overweight or obese is one of the risk factors for plantar fasciitis as it results in extra stress being loaded through the plantar fascia. Weight loss is therefore recommended as a preventative measure to plantar fasciitis.
• Choose the right shoes: avoid tight shoes, heeled shoes or shoes with poor cushioning or support. This is because poorly fitted shoes may affect the foot mechanics and distribution of weight through the foot.
• Self massage: to the plantar sole of the foot is a good way for releasing any tension of the plantar fascia. Rolling your foot over a massage or tennis ball is also a great way to release the plantar fascia.
• Strength and mobility training for the foot and lower leg: making sure you participate in regular exercises for stretching your calves and strengthening of your plantar arch, will help reduce your risk of plantar fasciitis.

Regular exercises focus on the calves and the plantar sole of the foot are considered a key factor for preventing plantar fasciitis. The best exercises involve:

• Toe movements.
  • Toe lift: Sit on a chair with your feet flat on the floor. Begin by lifting the big toe by itself making sure the other toes don’t move. Repeat this 10 times. Then lift your last 4 toes keeping the big toe on the floor. Repeat this 10 times and try on the opposite foot.
  • Toe abduction. Sit on a chair with your feet bare and flat on the floor. Try to lift the toes and then spread them. Repeat it 10 times.
  • Towel toe curls. Sit on a chair with your feet flat on the floor. Lay a towel or a tissue on the floor and place the toes of one foot on the side of the towel. Try to grasp the towel between the toes and pull it toward oneself. Repeat the exercise 5 times, before switching to the other foot.
• Calves stretching: Stand facing a wall with your hands on it. Put the leg you want to stretch about a step behind the other one. Keep your back heel on the floor and bend the front knee until you feel your are stretching the back leg/back calf. Hold this position for 30 seconds, then switch legs. Repeat this exercise 2-3 times every day.
• Plantar fascia and calves stretching using the stairs: Stand on a step and be sure to hold on to the banister. Lower the heels over the edge of the step and keep this position for 30 seconds. Repeat it 2-3 times per day. You should feel a gentle stretch across the soles of your feet and the back of your leg.
• Roll Stretch: Place a tennis ball under the sole of your foot and roll it back and forth from the heel to the toes. Continue rolling until your foot feels relaxed then switch to the other side.
• Toe stretch: Place the toes up on the wall with the sole of the foot and the heel on the ground. Lean into the wall until the plantar fascia stretch is felt. Hold the position for 30 seconds and repeat it 2-3 times per day.
• As an alternative, you can try the toe sit position: Kneel on the floor and bring the knees and feet together and tuck the toes under. Slowly take your buttocks towards the heels and try to sit on them. Keep this position for 30 seconds and repeat 2-3 times.

The NHS website suggests that you should go to your GP if:

• The pain is severe and it stops you from sleeping and doing normal activities.
• The pain has not improved after treating it yourself for 2 weeks (resting, icing the painful area, wearing wide comfortable shoes, stretching exercises).
• You have any tingling or loss of sensation in your feet
• You have diabetes, because foot problems can be more serious in case of diabetes