Plantar fasciitis is a degenerative disease that affects a tissue called plantar fascia within the foot, causing heel pain.
Plantar fasciitis is between the 5 commonest foot and ankle injuries professional athletes face in their career. It also affects around 10% of all runners.
In this article, we will discuss what plantar fasciitis is and the possible causes that can lead to the appearance of this disease. There will also be an explanation of the most common symptoms, which is the way to diagnose the disease and the treatment.
To keep learning about this topic, with information directly coming from a doctor, continue reading this article.
What is plantar fasciitis?
To know what plantar fasciitis is, we first need to understand what fascia is. This is a sheet of connective tissue that covers and connects muscles, bones, blood vessels, and nerves. Connective tissue is made of cells, proteins like collagen, and other substances depending specifically on where the tissue is.
The fascia is throughout the whole body from head-to-toe surrounding muscles. It also surrounds and attaches fat tissue, ligaments, joints, and many other things, as they go inside muscles as well. All of this allows the body to perform cohesively because the fascia is continuous throughout the body.
Although the fascia is continuous all over the body, there are different fascia in diverse parts. The continuity happens because they overlap each other. The plantar fascia locates in the sole of the feet, from the heel bone to the toes. In the beginning, the plantar fascia is just one sheath of thick connective tissue and then divides into 5 sheathes. This happens as it surrounds the tendons that flex the 5 toes in the foot. Nerves pass through and out of the fascia, mediating pain in the area. The plantar fascia also gives support and tension to our foot, involving other structures like the ankle.
Plantar fasciitis is the degenerative irritation of the plantar fascia, known by the general population as a heel spur. Both terms are a misnomer as the word fasciitis refers to inflammation, not an inflammatory disease. Not all patients present a heels spur, and not all with a heel spur have this disease. A heel spur is when there is a calcium deposit in the heel bone, causing a bony growth, sometimes painful. In plantar fasciitis, the patient habitually consults because of heel pain.
What is the main cause of plantar fasciitis?
As we already know, plantar fasciitis is a degeneration of the fascia in the sole of the foot. This can have various causes, but the main one is a biomechanical dysfunction of the foot that leads to microtears. What does this exactly mean? You may ask. This consists of excessive stretching of the fascia, which can come from various sources. When the micro-tearing perdures in time, it can become chronic plantar fasciitis.
When the cause is because a biomechanical dysfunction or biomechanical overuse, doctors say it is usually because of multiple factors. Most times, this degenerative disease affects athletes, specifically joggers, and runners. It also affects people who spend many hours standing up. But if it were only because of overuse, all runners or all teachers would suffer from plantar fasciitis. There are risk factors that will be discussed ahead that can make a person prone to suffering the disease.
Doctors are studying if other diseases can cause plantar fasciitis or may just cause heel pain without affecting the fascia. For example, there are rheumatoid illnesses like some types of arthritis that can cause degeneration of the fascia. A bone spur in this area leads to degeneration of the connective tissue of the fascia. Some infections as well could cause inflammation in the area, deteriorating the plantar fascia ligament. Other examples are traumatic events and tumors, which can cause a plantar fascia rupture.
What are the risk factors of plantar fasciitis? What makes it likely for someone to develop plantar fasciitis?
As the principal cause of plantar fasciitis is overuse, the main risk factor is being an athlete. They have a higher risk if they overdo exercise or do so in poor conditions for their feet. When runner extends their jogging time, distance or effort, they are at risk of suffering from microtears. Doing workouts uphill or indoors on poorly cushioned surfaces increase the risks as well.
People who jog or spend too much time on their feet have to be aware of what shoes they wear. There are specific types of shoes for each activity, whether the person is standing up for long hours or running. The thing is that these shoes wear out quickly, and some might prefer to ignore that instead of changing them. When this happens, the materials already lost their cushion properties, and a biomechanical dysfunction occurs.
There are risk factors that are proper to the person instead of coming from external sources. Having pes planus or pes cavus are both structural risks for developing plantar fasciitis. In the first, the normal arch we see in the foot is lower, and in the latter is higher. This increases the pressure on the fascia to resist tension and absorb the shockwave and weight of the body.
A difference in the legs’ length and abnormal torsion can put more stress on the fascia. A tight Achilles tendon, and tightness on the ligaments of the leg’s muscles in general, can be a risk.
Suffering from obesity is a major risk factor for plantar fasciitis because it puts extra weight on the fascia. People with diabetes are also at risk since a lot of them suffer from nerve problems in their lower limbs. This can make the person do damaging movements without them realizing it.
What are the symptoms?
The main plantar fasciitis symptom is the presence of foot pain, or more precisely, heel pain. This is a stabbing pain that appears when the patient just woke up and gave their first steps. It can begin to wear out as the day goes by but comes back later on after doing activities. They might walk with a limb or even on their toes to avoid the pain.
The doctor can place the plantar fasciitis pain around the medial calcaneal tubercle. It is the exact place where the fascia is attached. The patient does feel the pain around that area (in the heel), but sometimes it can go closer to the toes.
People can present stiffness in that area, especially around morning hours. Sometimes there can even be tight calf muscles. These are the ones that locate in the legs. This tightness can happen because of the adaptation in the walk that puts more stress on these muscles.
This type of disease can have emotional repercussions on patients, like causing depression. Plantar fasciitis can incapacitate a person from their normal activities such as doing exercise. It can affect the person’s work as well. For example, a surgeon who is used to standing long hours working no longer can have the same performance. The plantar heel pain is very much underestimated as it can be incapacitating.
Habitually, if this disease does not receive treatment or therapy, the patient can get chronic heel pain. Doctors and patients must be aware of this disease, as it affects 1 in 10 people. Most of these are women and also people around the age of 60.
How is plantar fasciitis diagnosed?
Healthcare professionals diagnose plantar fasciitis based on a medical history and physical exam. The professional in charge of the case would first collect the patient’s history. To do so, they would ask for characteristic symptoms like plantar pain in the medial heel area. It is important to consider whether this pain is noticeable with the first steps after inactivity. It will also ask if there are changes during the day, especially with the increase in activities.
When looking for symptoms, the physician would apply pressure to the sole of the foot to prove that the discomfort is coming from the plantar fascia. Then they could also evaluate movement and sensation. Besides, they will check for anatomical abnormalities, such as flat feet, pronation, or varus.
Different maneuvers can help the doctors to make the diagnosis. Like the positive windlass test, that is, heel pain reproduced with passive dorsiflexion of the toes.
Since being overweight is a risk factor, it is not uncommon to measure weight and height during the consultation to calculate their body mass index.
Imaging or other tests are not necessary to determine the diagnosis. However, they are often performed to determine the presence of other causes of foot pain. The tests include X-rays or MRI to rule out fractures, analyze diseases such as rheumatic gout, and the electromyogram, which highlights the possible entrapment of a nerve. Other differential diagnoses that should be taken into account because they can give similar results are heel spurs and calcaneal bursitis.
How is it treated?
In some cases, if plantar fasciitis is not treated or is not treated correctly, mild pain can turn into a chronic problem. Having foot pain can change the way of walking. These involuntary changes can stress other parts of the body, causing knee pain, hip pain, and back pain. For that reason, it’s important to receive plantar fasciitis treatment as soon as possible.
In general, there are simple steps that can reduce the symptoms of plantar fasciitis. Suppose doctors identify a clear trigger, such as a sudden increase in high-impact exercise. In that case, it may be helpful to temporarily suspend sports activity, as it may aggravate the situation.
There are shoe inserts that can be put into any pair of shoes, giving relief and helping reverse the damage of plantar fasciitis. All of this by adding heel support and helping distribute weight during movement.
At night, it’s common to keep the foot in a plantar flexion position, so the plantar fascia and the triceps suralis (calf) remain shortening, causing the patient to experience acute pain in the morning. For this reason, some specialists recommend a night splint to keep the foot dorsiflexed.
Stretching the calf muscles during the day can also be beneficial, as calf muscle retraction is caused by irritation.
A nonsteroidal anti-inflammatory drug, like ibuprofen, is available over-the-counter and can offer temporary relief. But If pain continues, doctors would recommend a corticoid steroid injection into the foot to decrease pain.
On the other hand, extracorporeal shock wave therapy is a procedure in which sound waves are transmitted through damaged tissues to induce and facilitate healing.
If the pain does not improve after a few months of conservative care, the doctor can recommend surgery. Plantar fasciitis surgery is known as a plantar fasciotomy.
How do you know if you have plantar fasciitis or heel spurs?
These two diseases can be very similar for various reasons, but it is important to understand their differences. First of all, what each of them is and consists of. Plantar fasciitis is the degenerative irritation of the plantar fascia, and most of the time happens because of biomechanical stress. Heel spurs are calcium deposits in the fascia that make a bony-like tumor.
One of the main differences between each other is that one of them can happen because of the other. In this case, calcium appears in the torn plantar fascia, leading to bone spurs. When the patient does not receive any kind of treatment on time, heel spurs can appear. When these don’t receive treatment as well, they can perpetuate damage in the heel by injuring the foot’s sole fat. This works as a cushion, and if it is not there anymore, it can prolong the disease.
Symptom-wise, both of them are pretty similar. The bone spur pain is more stabbing than the plantar fasciitis pain. The latter can be stabbing and may present pain surrounding other areas and have some swelling. Patients with heel spurs may feel the bony tumor, but not all patients recognize its presence unless it is big.
In terms of treatment, they both receive pretty similar approaches from doctors. Most of the time, it is to avoid activities that cause pain. Another thing which doctors recommend is to wear a heel cushion. This way, the area doesn’t receive too much pressure directly.
Should I walk with plantar fasciitis?
Some patients may be tempted to walk with plantar fasciitis for various reasons. The single fact of changing your life as it was going and take a rest is difficult for certain people. Changing the way you get to work or even the way you work can be challenging to stop exercising. But to not take a rest may only make the disease get worse.
To keep walking with plantar fasciitis can also cause other problems besides making the condition worse. As the patient cannot correctly take steps, they might adopt unnatural ways of walking. These can cause problems in other parts of the body, like the knees or the hip.
How to help prevent pain from plantar fasciitis? How to relieve plantar fasciitis pain?
Tightening the muscles in the feet and calves makes plantar fasciitis worse. Certain exercises could be very helpful in relieving and preventing pain. Most of these exercises are easy stretches that patients can do at home. Some may find it rather go to a place that provides physical therapy.
One of the most popular is the standing calf stretch. To do this, patients must place their hands on the wall for support and place the feet pointing forward, with the involved foot behind the other. The back leg should have a straight knee, and the front leg should have a bent knee. Roll forward, keeping the heel of the back leg on the floor so that they feel a stretch in the calf muscle of the back leg. This stretch can be repeated throughout the day.
Another very useful exercise is the toe extension. To perform this exercise, the patient must sit down with the affected leg crossed over the other. Grasp their toes with one hand and bend them up as far as possible to stretch their arch and calf muscle.
Many healthcare providers would also recommend rotating the ice massage bottle. With the foot involved resting on a frozen can or bottle of water, a golf ball, or a tennis ball, rock the foot back and forth over the object.
Do you have symptoms of this condition?
This tool is a Plantar fasciitis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses it the likelihood of having plantar fasciitis. Using the tool is free and would only take a few minutes.