Plantar fasciitis is one of the most frequent causes of foot pain and is an inflammatory process localized to the plantar fascia. It affects about 2 million people annually--data reported in the United States, 10% of the population developing the condition throughout life.
The plantar fascia is a band of fibrous tissue that originates at the heel and extends up to the five toes (the metatarsal bones), and is one of the structures that provides the resistance of the foot, the medial longitudinal arch support of the plant (foot). This fascia is stretched when the foot arch is flattening out, absorbing the impact force when the heel contacts the ground. The plantar fascia is not very flexible and therefore, after repeated stress small tears can occur.
It appears most commonly after age 40, more common in women, being influenced by changes in body weight (obesity, pregnancy), otherwise the disease may be correlated with body mass index (BMI). PF occurs in people who by profession sit down too long or walk for too long: teachers, waiters, military, police, postman, dancers and even athletes (especially those who run long distance).
There are several factors that can lead to plantar fasciitis, such as:
- Flat feet or the opposite, too high of an arch
- Orientation to the inside of the foot during walking
- Excessive pronation
- Inappropriate footwear--too high heels, shoes that do not provide arch support (sole too thin) sudden transition from heel to no heel
- Running on the heels or on soft surfaces (sand)
- Inflammatory trauma (rheumatoid arthritis, ankylosing spondylitis, lupus, reactive arthritis, psoriatic arthritis, etc.)
- Hereditary factors.
The Clinical Picture – Signs and Symptoms
Plantar fasciitis is manifested by sharp pain in the heel, usually at 4 cm below the heel or sole of the foot and median. The pain is intense in the morning, upon rising, taking the first steps after resting the night, but it can get worse when you start walking or do activities such as running. Typically it only affects one leg and does not appear at night, which distinguishes it from other joint diseases, neurological or bone diseases, which can develop at this time. It is also associated with limiting posterior flexion of the ankle, the plantar fasciitis stretching site can be painful, and in runners there is increased likelihood of knee pain. 70% of plantar fasciitis patients may experience the development of bone growths, a "spur" on the heel,which is often considered responsible for painful symptoms. In fact, chronic plantar fasciitis can lead to the calcaneus "spur" and its surgical removal does not ease symptoms because the true cause of the pain is actually in the fascia.
Diagnosis
Usually clinical diagnosis is required. Patient examination includes inspection and palpation of the foot, observing the leg while standing and during walking. The doctor decides if you need additional imaging, usually to rule out another condition, such as radiography, ultrasound or MRI.
Treatment
Plantar fasciitis treatment usually requires a multifaceted approach with very effective and lasting results. Ultrasound, soft tissue treatment (Graston technique), stretching, massage and instrument adjusting of the feet and legs to improve biomechanics. Use of arch supports (orthotics) is also recommended to help maintain the correction and reduce the likelihood of recurrence. This conservative approach works very well for the majority of Dr. Furbee's patients. The alternative is to get injections or surgery as a last resort. The risk of complications is relatively high for surgery.
Hygienic-dietetic treatment consists of:
- Weight loss
- Wearing arch support shoe inserts
- Rest
- Wearing appropriate shoes with low heels (3-5 cm)
- Avoid walking barefoot on hard surfaces and/or uneven ground
- Ice massage at home to reduce inflammation
With the right care and supervision, plantar fasciitis treatment can be non-invasive and relatively fast, so schedule an appointment today to get your foot checked out by a professional.