February 27, 2020
What is Plantar fascia?
Plantar fascia is a long, thin strong band of tissue in the sole of foot, extending from the heel to the front of the foot. It acts like a shock absorber and supports the foot arch.
What causes plantar fasciitis?
It is believed that plantar fasciitis is caused by damage or irritation of plantar fascia due to excessive strain resulting in heel pain and stiffness. The pain is most often felt below the heel close to the site of attachment of plantar fascia to the heel bone. In majority of cases a specific cause or reason cannot be identified although certain factors can predispose one to the development of this condition. These include
- Constantly being on your feet, especially on a hard surface
- New/ increased activity or repetitive impact activity such as running/sports (especially involving hard surfaces /courts)
- Tight calf muscles
- High foot arches or flat feet
What are the symptoms of plantar fasciitis?
Plantar fasciitis is most common in people between the ages of 40 to 60 years, although it can occur at any age. It is twice as common in women compared to men.
Common symptoms of plantar fasciitis include:
- Sharp, burning or aching pain on the bottom of the foot near the heel. It can extend till the arch area of the foot.
- Pain with the first few steps in the morning or after period of rest. The pain generally subsides after a few minutes of walking
- Increased pain after exercise or activity
How is plantar fasciitis diagnosed?
The diagnosis is made clinically based on the history and examination findings. In clinic ultrasound scan can help confirm the diagnosis.
X-rays are used for ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs (small piece of bone that can grow on the underside of the heel bone) are often seen on an x-ray. Approximately 3 in10 people have a heel spur and few of them have heel pain
Magnetic resonance imaging (MRI) scan is sometimes requested to confirm diagnosis and rule out other conditions with similar presentation.
What are the treatment options for plantar fasciitis?
Plantar fasciitis is commonly described in the literature as a self-limiting condition. A significant number of patients with improve within 10-12 months, although it can be disabling and impact negatively on the quality of life. Treatment options include
- Rest/ Activity modification. Decreasing or stopping the activities that make the pain worse especially activities such as running/ step aerobics where the feet pound on hard surfaces
- Ice. Rolling your foot over a cold water bottle or ice can help. Applying ice wrapped in a towel to the affected area helps reduce pain. This can be repeated 3 to 4 times in a day. Avoid using for too long or applying directly to the skin as it can cause ice burns.
- Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. These should be used as advised by your doctor.
- Exercise. Plantar fasciitis is aggravated by tight feet and calf muscles. Stretching the plantar fascia and the calf muscles several times a day, can help to relieve the pain. Night splints work by creating a constant mild stretch of the plantar fascia and they do need to be worn for some time before the effects become apparent. Tolerability can be an issue and in some cases even putting them on for 10 min before betting out of bed in the morning can be helpful in reducing the early morning symptoms.
- Weight management – healthy body weight can help by reduce the load on the plantar fascia.
- Supportive shoes and orthotics can help in reducing the impact / heel irritation especially in individuals with flat feet. Avoid walking barefoot and use supportive footwear with a stiff outer sole and a shock absorbing insole. Custom made orthotics are more likely to be better tolerated although there is no strong evidence to show that custom made orthotics lead to more improvement.
- Extracorporeal shockwave therapy (ESWT)– this option is utilised more for runners as there is some evidence of effectiveness in this subgroup.
- CORTISONE/ STEROID INJECTIONS – this is a common treatment choice for patients not resolving to simple measures. There is moderate quality evidence demonstrating the short term beneficial effects of these injections. It is best to perform the injections under ultrasound guidance as this increase the accuracy of injections. Using low doses of steroid can help limit the potential local side effects. You may be asked to avoid running and other high impact activities for some time (approx. 2 weeks) after the injection.
- PRP injections. Platelets are one of the blood components. They help in clotting and contain growth factors which promote the healing process. PRP is prepared from one’s own blood by placing it in a spinning machine to separate the platelets. Growth factors released from the platelets influence and accelerate the repair process, utilising body’s natural healing ability. These injections are best performed under ultrasound guidance and have the potential of providing prolonged relief.