What is Plantar fasciitis?
Inflammation of the plantar fascia It is among the most frequent causes of Heel Pain. Collagen disorganization in the absence of inflammatory cells causes plantar fasciitis, an overuse condition of the plantar fascia at its attachment to the calcaneus.
Pain usually feels on the medial side of the heel and rises gradually. It begins feeling worse in the morning, gets easier with activity, and often becomes easier after an activity. When activity starts again during periods of inactivity during the day, pain usually increases.
When the condition becomes worse, it may be painful to bear weight and worse when you motion. The pain associated with plantar fasciitis is usually severe in the morning, becomes less with exercise at first, and goes worse after standing.
How does the pain of plantar fasciitis feel?
An aching pain in the heel or along the bottom of the foot is typically the result of plantar fasciitis. Depending on your activities and the time of day, the pain might shift.
You may experience the following types of pain;
- Pain upon waking up from sleeping or sitting down.
- The discomfort usually goes away after a short while of walking.
- A dull, persistent pain.
- Piercing or stabbing pain when applying pressure to your heel or using the afflicted foot.
- Even though moving around or working out could make you feel better temporarily, as soon as you stop, the pain will almost always return.
- Elevated pain when you wake up from sleep or after sitting for a long time.
Anatomy
- The term “plantar fascia” or “plantar aponeurosis” refers to the thick connective tissue aponeurosis that supports the arch on the plantar foot.
- There are three segments that comprise the plantar aponeurosis, and they all originate from the calcaneus.
- This plantar aspect of the posteromedial calcaneal tuberosity aids in the insertion of the abductor hallucis, quadratus plantae, and flexor digitorum brevis muscles, the most important of which is the segment that forms the longitudinal arch of the foot through inserting into the toes.
- The aponeurosis provides the longitudinal arch both dynamic stress absorption and static stability and an important role in dynamic function during gait cycle.
Plantar faciitis causes
- The high arch, or pes cavus, and the flat foot, or low arch
- In flat feet will cause greater strain on the plantar fascia’s origin at the calcaneus as the fascia attempts to maintain the arch stable during the propulsive phase of the stride.
- There may be too much stress in the heel area of a pes cavus foot due to the foot’s inability to take in stress and adjust to the ground.
- It is most commonly present in tightness in proximal muscle structures, specially in the calf, hamstring and gluteal regions. since the body’s fascia stretches its whole length.
- In older patient It might be related to prolonged walking in poor or unsupportive footwear.
- Obesity and prolong standing posture
- Typically arises from activities (like running and dancing) requiring to maximal ankle plantarflexion and simultaneous metatarsophalangeal joint dorsflexion.
Clinical features of plantar fasciitis
- It is wrost painful at morning time, reduces with activity and frequently painful to post activity
- pain is commonly of gradual onset and felt classically on the medial aspect of the heel.
- Pain might be present in the weight-bearing position and increase with activity.
- Acute tenderness over the medial tuberosity of the calcaneaus and might be medial border of plantar fascia.
- Calf tightness present
- Plantar fascia is usually tight and during plantar fascia stretching, it might be reproduce pain
Diagnosis
Diagnosis of plantar fasciitis by using history, examinationation ,investigation
History and Examination
- Plantar fasciitis pain usually occurs due to insidious onset, there is fat pad damage might be occurs due to any single traumatic episode (e.g. jumping on heel from a height)
- Repeated dorsiflexion on hard or uneven surface with unsuitable neel support
- History of poor shoe wear, walking and running on hard surface
- Examination include ankle, subtalar and midtarsal joint
- Range of motion necessary; it might be reduce dorsiflexion range
- Running shoe observation and examination are necessary
- Examination of rapid increase running meters, running on uphill steps
Investigation
- MRI
Plantar fasciitis can be confirmed as present and to be significant using an MRI and increased signal intensity and thickening are seen on MRI at the medial calcaneal tuberosity, in which the plantar fascia connects to the calcaneus. This may be accompanied by edema in a neighboring bone.
- Ultrasound
Plantar fasciitis can be confirmed as present and to be significant using an ultrasound and shows a distinctive region of hypoechogenicity.
Differantial Diagnosis
It is important to rule out the below mentioned conditions because there some resembles symptoms are present
- Plantar fascia rupture
Prior plantar fasciitis symptoms with a “pop” or “crunch” during push-off or pivoting and difficulty in weight bearing
- Calcaneal Apophysitis
Symptoms are similar to the plantar fasciitis but tenderness not present over the medial arch. Symptoms present over the physis and immature skeletally present with inflamation.
- Tarsal Tunnel Syndrome
Only the plantar part of the foot perceives pain, numbness, or tingling in the medial aspect of the ankle. No tingling or numbness around the dorsal foot.
- Joggers Foot
Commonly occurs due to hindfoot deformity (mostly pronation) and long distance running. characterized by neuritic pain produced on by running (medial arch) that passes the medial plantar nerve’s distribution to the medial aspect of the toes.
- Posterior Tibial Tendon Insufficiency
Pain most commonly seen in medial aspect rather than posterior or inferior. Difficulty or inability to raise unilateral heel. Tenderness and boggy area over medial aspect along with the course of posterior tibial tendon.
Risk factors:
Plantar fasciitis may develop for no obvious reason, but there are a few things that can make it more likely for you to get it.
Among them are;
- Age
Most patients with plantar fasciitis are in the 30- to 60-year-old age range.
- Mechanics of the foot
The distribution of weight while standing can be impacted by flat feet, high arches, or even an unusual gait pattern, which can increase strain on the plantar fascia.
- Being overweight
Extra weight puts additional strain on your plantar fascia.
- Professions that require you to be active
A hig her risk of developing plantar fasciitis can be found in workers in factories, classrooms, and other occupations where standing or walking on hard surfaces is a daily routine.
Treatment
Treatment planning is based on the patient’s condition and level of severity. Only when alternative therapies, like medication or lifestyle modifications, show early treatment failures do they need surgery.
Non-surgical treatment
- NSAIDs, which some people report to be effective in previous-year evidence
- Corticosteroids injection
Injections of corticosteroids may be effective in the short term, but for them to prevent recurrence, they must be utilized in combination with other treatments, including stretching and biomechanical correction.
Surgical Treatment
Surgery might be necessary for people who don’t improve after receiving proper treatment.
- Plantar fasciectomy
Fascia, or the connective tissue surrounding your muscles, is cut away from your heel bone. A plantar fasciectomy involves making an incision and removing any wounded or inflammatory tissue.
Physiotherapy Treatment
Physiotherapy treatment protocol is essential for plantar fasciitis mculoskelatal dysfunction and self treatment technique. Physitherapy treatment in this condition is more beneficial than medical and surgical treatment
- For the anti-inflammatory effects, apply massage with ice or cryotherapy for ten minutes over the affected area.
- Self plantar fascia stretching
Patient in seating position, graps all five toes and strech towards knee , holds for 30seconds , 5 repetitions/day.
- Avoid overusing activity, running and prolonging weight bearing activity
- Taping
When treating plantar fascia, the foot is inverted by first applying tape to the skin across the medial arch, then moving from the lateral aspect of the dorsum of the foot across the plantar aspect.
- Deep friction massage
- Gastrocnemeus and soleus stretching
- Strengthening exercises
Strengthening exercises for the foot’s intrinsic muscles aims to reduce stress on the plantar fascia to improve longitudinal arch support. Calf raises 10 repetition 2 times/day
- Shoes with midsoles and arches that are properly supported
How Can Plantar Fasciitis Be Prevented?
Although plantar fasciitis totally preventable through physiotherapy treatment, there are a number of steps you can take to lower your risk or reduce the condition’s progression.
Here are a few self-care methods for prevention:
- Regular stretchinng
Stretching focus on the plantar fascia, gastrocneumis, soleus, tibialis anterior, and hamstring muscles is recommended because the fascia continues through the lower extremity.
- Avoid prolonged weight bearing and prolonged activity
Long physical activity has the potential to worsen symptoms and put more strain on the plantar fascia. There is a possibility that new development causes will arise as a result of symptoms. So, stay away from weight-bearing activities while the condition is acute.
- Cryotherapy
For sportspeople, cryotherapy is essential before and after activity. It can reduce pain through vasoconstriction.
- Proper shoes
Shoes with midsoles and arches that are properly supported.
Summary
Plantar fasciitis is an uncomfortable condition that affects the heel and the plantar fascia from overuse. Mainly, the medial arch of the foot causes pain, starts before and after activity, and is the first step after getting out of bed. Plantar fascia and other proximal muscles have tightness present. Painful during weight bearing and motion.
The causes of plantar fasciitis are Pes lanus (Flat foot/low arch) and Pes cavus (high arch). Plantar fascia is usually tight, and during plantar fascia stretching, it might cause pain. In older patient It might be related to prolonged walking in poor or unsupportive footwear, obesity, and prolonged standing posture
To improve the flexibility, mobility, and stability of the foot and ankle, the first line therapy is conservative and consists of injections of NSAIDs and corticosteroids, activity modification, physiotherapy, pain management, stretching of the plantar fascia and other proximal muscles, and strengthening exercises for the intrinsic muscles of the plantar and ankle. Procedures for plantar fascia sometime may be necessary if non-surgical treatments prove ineffective.
FAQ:
Is there an effective therapy for plantar fasciitis?
Conservative treatment for plantar fasciitis typically consists of icing the affected area, stretching, and modifying or avoiding painful activities. The majority of patients heal in a few months.
What causes plantar fasciitis?
Plantar fasciitis is an inflammatory condition affecting the plantar fascia, a tissue in the foot used for walking and other foot motions. Plantar fasciitis can result from a multitude of factors, including walking surface types, shoe types, and the structure of the foot. Plantar fasciitis’s main symptom is heel pain.
I have plantar fasciitis; can I still lead a normal life?
It’s critical to get treatment for plantar fasciitis in order to prevent the pain from interfering with your regular activities and to prevent knee or hip issues from changing your gait as a result of the discomfort.
Is walking safe when suffering from plantar fasciitis?
Walking may actually exacerbate plantar fascia inflammation, requiring a longer course of treatment. Even though walking by itself is unlikely to aggravate the ligament, plantar fasciitis can worsen if you don’t wear the proper shoes or overexert yourself.
Does plantar fasciitis respond well to massage?
Before moving on to more involved treatment methods, doctors may suggest conservative treatment for plantar fasciitis, such as stretching and massage. In order to facilitate healing, massage can help stretch the plantar fascia and improve blood flow to the area.
Is plabntar fasciitis a chronic condition?
Treatment typically results in improvement of plantar fasciitis, which is neither chronic nor permanent. After receiving conservative care for a few months, the majority of patients fully recover. Additionally, you have a wide range of choices at your disposal. Conservative treatment approaches are effective in treating plantar fasciitis in many cases.
I have plantar fasciitis; for how long should I avoid walking?
With plantar fasciitis, you are able to walk as much as you like. You can stop if it starts to hurt, but if you continue walking, nothing will get damaged. The ideal shoes for plantar fasciitis are those that fit properly, offering arch support along with the right length and width.
How severe is plantar fasciitis?
Challenges. If plantar fasciitis is not treated, it may lead to persistent heel pain that interferes with daily activities. To try to prevent plantar fasciitis pain, which can cause issues with your feet, knees, hips, or back, you probably need to modify the way you walk.
Can my normal life continue despite having plantar fasciitis?
It’s important to get treatment for plantar fasciitis in order to prevent the pain from interfering with your regular activities and to prevent knee or hip issues from changing your gait as a result of the soreness.
References:
- Plantar fasciitis: symptoms and causes – Mayo Clinic. (2023, September 7). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846
- Garg, M. (2007). Clinical Sports Medicine, 3rd Edition. The journal article “Medicine & Science in Sports & Exercise,” 39(5), 898, doi:10.1249/01.mss.0000257793.11280.55
- Plantar fascia. October 5, 2023. According to recent studies, the midfoot may be the source of plantar fasciitis, according to Wikipedia.
- Image 1, Pain From Plantar Fasciitis Using Neuragenex NFPM Protocol. 2024, June 12. relatyv.com. Plantar fasciitis can be treated using Neuragenex-nfpm at https://relatyv.com/
- Image 2 and 3,Wilk, Kevin E.; & Brotzman, & N, S. Brent, 2007
- October 26, 2020, Pietrangelo, A. The Full Report on Plantar Fasciitis Surgery: Results, Recuperation, and More. Plantar fasciitis surgery: https://www.healthline.com/health/about