Plantar fasciitis is an inflammation of the plantar fascia at the sole of the foot. This fascia connects the bottom of the heel to the ball of the foot and has a function in walking and running; it provides spring force to the pass. The condition is actually more a damage than an inflammation. Plantar fasciitis is one of the most common causes of pain in the heel.
Plantar fasciitis is an overload injury. Frequent load of the fascia can lead to microcracks, which in turn can cause inflammation and degeneration of the connective tissue (collagen) in the fascia. The condition can quickly lead to deterioration. When plantar fasciitis occurs for a long time, there is often calcification in the attachment of the fascia to the heel bone, which is called heel spur. However, this isn’t the cause of the pain or the condition but a consequence of the inflammatory processes.
Athletes with a high load on the fascia, such as runners and people doing jumping sports, are at increased risk. This is particularly the case if exercise intensity increases significantly or when trained on inadequate surface. A trauma, such as a hard landing on a flat foot, can lead to plantar fasciitis. There is also an obvious relationship with overweight. The condition is further associated with excessive rolling inward of the foot.
People with plantar fasciitis often feel a lot of pain after a period of rest, especially in the morning when stepping out of bed. The pain may occur along the entire length of the fascia, but in most cases is located at the place where the fascia is attached to the bottom of the heel bone. After the first passes, the pain temporarily goes away. The pain may also begin while walking or running. In that case, the pain radiates from the bottom of the heel to the toes.
The doctor can make the diagnosis of plantar fasciitis after examination of the foot. The foot is obviously sensitive at the place where the fascia is attached to the heel bone, or at the ball of the foot. An X-ray can demonstrate the presence of heel spur, that protrudes from the front of the bottom of the heel bone. This heel spur is an offshoot of the bone, which has emerged in the course of time.
In the past, many treatments for plantar fasciitis have been proposed, but no single treatment has proved really effective. There are three main pillars underpinning the treatment: reducing inflammation in the acute stage, reducing the load on the fascia and restoring muscle strength and flexibility.
Reducing the inflammation in the acute stage can be done by taking a bath of ice water or by putting ice on the painful area. Furthermore, anti-inflammatory drugs (NSAIDs) can be used for some days. Proper (sports) shoes with firm support of the foot arch are necessary. In severe cases, lower leg casts (sort of braces) can be worn. All kinds of other measures may be needed, such as using tape or straps that support the foot arch, the use of particular preparations, corticosteroid injections in the heel, physical therapy, orthotics and applying a splint at night in order to stretch the calf muscles and the fascia during sleep.
More recently, the so-called Extracorporeal Shockwave Therapy (ESWT) has been promoted. This treatment can be used when the symptoms persist for several months and the above-mentioned treatments have no effect. ESWT uses strong ultrasonic sound waves that penetrate the soft tissues.
Surgery may be considered when the pain persists for more than a year and the treatment is not effective enough. However, the recovery time is significant and lasts at least four months.
The condition generally passes automatically after about one to two years. Most cases of plantar fasciitis respond well to treatment with complete disappearance of the pain over time. Some people will permanently have to wear orthotics to prevent a recurrence. Surgery reduces the pain in most cases, but a quarter of the patients continues to have pain.
- Use good running shoes that absorb shocks. Old running shoes lose their shock absorbing properties, so replace them in time.
- If you suffer from overpronation, it’s important that the shoes are tailored. Special orthotics are sometimes needed. Whether a person overpronates, can be seen the way the shoes wear: the sole wears off sooner at the inside of the heel and forefoot, at the big toe and the ball of the foot.
- To ease the pressure on the fascia, it’s better to take shorter steps and not walking barefoot. Activities in which the leg comes down hard, such as running, should be avoided.
- The patient may need to lose weight.
- The healing process can often be accelerated by stretching the calf muscles.
- With orthotics in well-fitting shoes, a person stands with a slightly higher heel. The soles can also provide cushioning and support of the heel.