Plantar Fasciitis

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What is Plantar Fasciitis?

If you feel a sharp, stabbing pain in your heel when you wake up in the morning or stand up from your chair after a long day of work, you may have plantar fasciitis.

Plantar fasciitis is the most common cause of heel pain and affects a significant number of people. It is caused by inflammation or degeneration of the plantar fascia, a thick ligamentous structure that connects your toes to your heel.

Fortunately, there are a variety of simple treatments and methods that can be used to improve your condition and relieve the pain in your heels.

Symptoms

Plantar fasciitis usually manifests as a stabbing or aching pain at the sole of your foot, near the inner side of the heel. The pain is typically the worse on standing and walking after a prolonged period of inactivity, such as after waking up in the morning or after sitting at the desk for a while. The pain is generally alleviated by movement and simple stretching exercises.

What causes Plantar Fasciitis?

Normally, the plantar fascia functions like a spring, maintaining the medial foot arch while helping to cushion the impact of various weight-bearing activities like running, walking and standing. However, the plantar fascia can sometimes get damaged or inflamed from overuse or trauma, resulting in significant discomfort and heel pain.

Overuse

One of the most common causes is overuse. It commonly affects runners or people who spend prolonged hours walking or standing. Repeated wear and usage of the plantar fascia causes microscopic tears and injuries, resulting in inflammation and increased heel pain, and which can ultimately lead to degenerative changes and the formation of bony heel spurs.

Other foot and ankle conditions

Patients with concomitant foot and ankle conditions are also more predisposed to plantar fasciitis, such as:

This is because such conditions create extra mechanical strain on the foot and the increased forces are transmitted to the plantar fascia.

Improper footwear

Another easily treatable cause of plantar fasciitis is improper footwear. Ill-fitting shoes that have poor heel support, poor padding or flat soles do not adequately cushion and support your feet, resulting in heel pain.

There is a common misconception that heel spurs – small bony formations protruding from your heel – are the cause of the heel pain felt in plantar fasciitis. However, this is usually not the case, as the pain originates from the inflamed plantar fascia itself. The spurs are the result of degenerative changes from chronic damage to the plantar fascia, but are not the cause of the plantar fasciitis. Hence, there is no need to remove the spurs.

Who is more likely to have Plantar Fasciitis?

The risk factors below may increase your chances of developing plantar fasciitis, and other foot and ankle problems. Some of the more common risk factors for plantar fasciitis include:

Age
People between the ages of 40-60 are most commonly affected by plantar fasciitis.
Obesity
Being overweight or obese causes increased pressure on the plantar fascia and heel. This also increases your risk of other orthopaedic conditions such as ankle sprains, painful bunions, and hip and knee arthritis.
Prolonged standing or walking
Some occupations or lifestyles may involve long hours of standing or walking, and stress to the plantar fascia is unavoidable. This strain may be further exacerbated by walking or standing on hard or uneven surfaces.
Excessive exercise
Exercising at an intensity or duration to which one was previously unaccustomed may result in an acute strain to the plantar fascia, increasing the risk of progression to plantar fasciitis if there is inadequate rest time in between training sessions.
High-impact sports
Certain high-impact sports such as running, basketball, soccer or dance can cause excessive wear and tear of the plantar fascia over time, causing plantar fasciitis.

How is Plantar Fasciitis diagnosed?

Plantar fasciitis is typically a clinical diagnosis, which means that your doctor is likely to be able to diagnose it by speaking to you and taking a detailed history of your symptoms and understanding the nature of your pain, as well as taking note of any risk factors or predisposing foot conditions that you might have.

After getting a comprehensive overview of your heel pain, your doctor will proceed to examine your foot and ankle, evaluating the structure of your foot (including pes planus or pes cavus), identifying the exact location of the pain and tenderness, and checking the nerves and blood vessels of the foot.

Since there are other possible causes of heel pain, such as stress fractures, ligamentous injuries, nerve compression, Achilles tendon conditions, heel pad problems, or arthritis, your doctor may order additional imaging such as X-rays or MRI scans of the affected foot and ankle to confirm the diagnosis and rule out these other causes.

What are my treatment options?

Fret not, as the symptoms of plantar fasciitis such as heel pain can often be resolved with simple exercises and lifestyle modifications.

Simple exercises
Since plantar fasciitis is related to tight ankle tendons and calf muscles, these convenient stretching exercises help to warm up your foot and ankle and reduce heel pain. It is very important to perform plantar fascia-specific stretching exercises regularly, and this can be helpful for up to 90% of patients.
Good footwear
Well-fitted shoes with adequate cushioning and heel cups are essential in keeping your heel pain at bay. With proper foot and ankle support, the plantar fascia will experience far less strain, and you’ll be able to walk and stand with less pain!
Night splints
The plantar fascia tends to become tighter overnight, due to the natural position of the foot, and you may wake up in the morning with heel pain. A night splint can hold your ankle at the optimal angle, stretching the plantar fascia and Achilles tendon (ankle tendon) overnight, and some patients may find this helpful.
Painkillers
If the pain affects your function significantly or prevents you from walking or standing at work, your doctor may offer painkillers to alleviate the symptoms.

The vast majority of patients improve and no longer experience heel pain after 3 months of treatment. However, in some cases, the pain persists, and other treatment options may be offered:

Orthotics

If you’ve tried buying proper footwear or heel cups and the pain persists, custom orthotics may be your next option. Special shoe inserts can be made by podiatrists, to relieve areas of strain and correct abnormalities in your foot alignment.

Autologous Plasma Injections

Autologous plasma (Platelet) injections administered to an area around the heel will act as a booster to speed up healing and decrease the pain from your injured plantar fascia, with minimal discomfort and risk. This has been shown in studies to be successful in treating 80-90% of patients who have persistent heel pain from plantar fasciitis, and has become a preferred treatment option for patients with chronic plantar fasciitis.

Shockwave Therapy

This uses shockwaves administered by a device placed on the skin over the injured area of the heel to stimulate healing. The drawback of this technique is that it can be uncomfortable, and typically requires several sessions (a week apart) to complete the course of treatment.

Surgery

This is rarely done and is only recommended in patients who have persistent heel pain of over 6-12 months, after trying the options listed above. It involves making a small incision over the plantar fascia to release the tension and strain in the structure.

When should I see a doctor?

If you have persistent heel pain that is affecting your daily life or work, do arrange for a consultation with your doctor to obtain an accurate diagnosis (as there are multiple causes of heel pain) and receive proper treatment. Early diagnosis and prompt treatment of plantar fasciitis often leads to the best results, and seldom requires invasive surgical treatment, allowing you to return to your work, daily activities and sporting pursuits rapidly!

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