A "pain in the neck" irritates you and a "pain in the heel" is no better! Waking up with a tightened heel area is not a good experience to start your day! Plantar fasciitis is one of the common causes of pain in the heel. It can be described as the irritation and the inflammation of the plantar fascia at the foot. Plantar fascia is a thick band of connective tissues which supports the arch and deep structures of the foot. It is also known as plantar aponeurosis. It almost spreads along the entire length of the foot.
The plantar fascia starts on the bottom surface of the heel and extend along the sole of the foot towards the five toes. The plantar fascia works like a rubber band between the heel and the ball of your foot to form the arch of your foot. The overutilization, overpronation or repetitive stretching of the fascia makes it inflamed and painful. The population who are at a greater risk of suffering from plantar fasciitis are the obese individuals, people with the improper foot arch (especially the ones with the high-arched feet), those using shoes with inappropriate soles and the ones who are experiencing repeated stress on the insertional point of the fascia (ball of the toes near forefoot) due to prolonged running.
What are the Symptoms of Plantar Fasciitis?
Sharp pain is felt on the medial part of the foot. The pain is in its worst condition in the morning and the first few steps prove to be extremely painful. The pain tends to lessen with activity, but a burning sensation or a dull ache can still be present during the activity. Mild swelling and tenderness at the medial and the bottom part of the heel are the common signs of fasciitis. The pain gets aggravated by the dorsiflexion of the ankle (upward movement of the foot at the ankle joint in a direction that beings toes closer to the body and away from the surface) and while standing on the toes. Windlass test, in which an individual is asked to do toe-walking, is also helpful in diagnosing plantar fasciitis. X-ray and MRI will also help to examine whether the pain is caused by other conditions such as heel spur or a stress fracture.
How can Plantar Fasciitis be Treated?
Treatment depends on the severity of the condition. There are two main options- Conservative management and Non Conservative management.
Conservative Management
Majority of the cases shows positive responses to conservative management and it mainly includes:
- Anti-inflammatory medicines, like nonsteroidal anti-inflammatory drugs (NSAID), can ease pain and inflammation. Corticosteroids can also be administered through iontophoresis (a technique which allows an entry of medicines through the skin via the use of a small electric charge) and injections.
- Physical therapy mainly includes stretching exercises to stretch the plantar fascia, application of ice pack in the acute stages to reduce pain and inflammation and tapping the affected area.
- Orthotics such as customized arch supports, heel pads, night splints to hold the plantar fascia and the achilles tendon in lengthened position and the use of walking casts can also help to ease the condition.
- Shockwave therapy, more specifically the extracorporeal shock wave therapy, is one of the latest procedures applied to treat plantar fasciitis. In this procedure, sound waves are directed at the affected area to stimulate healing. It is usually recommended in chronic conditions where other conservative management has not responded very well.
Non Conservative Management
Non Conservative management includes surgical procedures to release plantar fascia from its bony attachments. Very few people have to undergo surgery after they have failed to experience recovery signs from the conservative methods. Recently, ultrasound-guided percutaneous fasciotomy technique ( surgical procedure to release tight fascia) has been found to be effective to treat persistent plantar fasciitis.
You will definitely want to treat your condition before it starts producing a crippling effect on you. Living with pain and discomfort is a pain itself. New studies are coming up with new methods of treatment more frequently. If one treatment fails, another option is open to you! With the advancements in medical sciences and rehabilitation, the prognosis and recovery rate in plantar fasciitis is much higher. But sooner the better!
