The plantar fascia is a flat, thick, fibrous structure made up of connective tissue located on the sole of the foot that originates from the calcaneus and inserts into all the proximal phalanges forming the arch of the foot. This thick fascia or ligament stretches with each step (the plantar fascia is also known in many texts as the arcuate ligament ).
What is plantar fasciitis?
Plantar fasciitis is the most common heel pain condition. This condition occurs when the fibrous ligament of the plantar fascia along the bottom of the foot causes tears in the tissues, leading to pain and inflammation.
Plantar fasciitis pain is usually located near where the fascia attaches to the calcaneus, also known as the heel bone. Although the pain in the acute phase can develop in the inner part of the ankle.
Plantar fasciitis. What is it, causes and treatment
In this video it will be explained what plantar fasciitis is, as well as its possible guidelines and also, possible guidelines for its treatment:
Causes of plantar fasciitis
The causes of plantar fasciitis can be varied and multifactorial, it depends largely on environmental, postural, and genetic factors. Below we offer you a list of the most common causes of the appearance of this disease.
Overload due to physical or sports activity
The plantar fascia is like a rubber band that loosens and contracts with movement. Also, it absorbs weight and pressure. Due to this function, plantar fasciitis can occur for various reasons: among the most common is the overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and usually suffer from it.
Another reason is excessive running, jumping, or other activities that can easily cause repetitive or excessive stress to the tissue and lead to tears and inflammation, causing moderate to severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to severe plantar fasciitis.
Achilles tendon retraction
Another cause of this disease can be the retraction of the Achilles tendon, or also due to the mechanics of the foot. Having conditions such as flat feet or high arches ( know the different types of foot strikes ), or having a gait disturbance (the way the foot hits the ground), the fascial tissue may be overworked or stretch abnormally, leading to tears and swelling.
If the foot support is not correct, it can cause abnormal tension on the plantar fascia, predisposing it to Enthesitis.
Another common cause of plantar fasciitis is arthritis. Certain types of arthritis can cause inflammation in the developing tendons, leading to plantar fasciitis. This cause is particularly common among elderly patients.
Diabetes is also a factor that can contribute to heel pain and further damage, particularly among the elderly. This disorder should not be confused with gout, a disorder that mainly affects the feet and knees.
Gout is the accumulation of uric acid in the joints, it is very painful and often originates from a diet rich in red meat.
Wrong or faulty footwear
Among the most popular contributing factors to plantar fasciitis is wearing the wrong shoes. In many cases, the shoes; either they don’t fit properly, or they provide inadequate support or cushioning. While walking or exercising in inappropriate shoes, weight distribution is poor, and significant stress can damage the plantar fascia ligament.
In short, plantar fasciitis is an inflammation of the arcuate ligament commonly known as the plantar arch (enthesitis), which can be caused by repetitive microtrauma or overuse. Many athletes suffer from plantar fasciitis, especially those who play track and field, soccer, tennis, and basketball.
An amateur is more prone to fasciitis than a professional, both because of the footwear and because of the speed of the race, in fact running slowly can cause an acute inflammation of the plantar aponeurosis. The most affected are adults who are overweight and play sports.
Risk factors for plantar fasciitis
With so many causes of plantar fasciitis, there are many risk factors to be aware of. One of these factors is activity in sports and regular exercise can put significant stress on the heel and surrounding tissue. Also, if you have flat feet , you should consider having an orthopedic shoe padding to counteract the stress caused by abnormal foot mechanics. Another important factor would be age also plays a role. As we age, tissue tends to become weaker and more prone to damage.
In addition to these common risk factors, weight plays a very important role in heel damage. In the heels, much of the pressure of the body is absorbed when we walk, being overweight can easily lead to damage and plantar fasciitis. Pregnancy can also add a few extra pounds. However, hormonal changes in pregnant women can also cause ligaments and other tissues to relax and become more flexible, which could lead to plantar fasciitis if care is not taken.
Those who are on their feet all day due to their occupation are also at risk. Finally, wearing high heels, boots or other shoes that do not provide adequate heel and arch support can easily lead to plantar fasciitis over time.
Symptoms of plantar fasciitis
The most common complaint of plantar fasciitis is a burning sensation, or stabbing pain in the heel of the foot. Most patients will feel this in the morning, because the fascial ligament contracts at night while we sleep; causing pain when stretching it again when we get up since when we get out of bed and pressure is exerted on the ligament, it tightens and the pain is very sharp.
The pain usually subsides as the tissue warms, but it can easily return again after long periods of standing, physical activity, or after getting up from a long period of sitting.
The pain is strong and can become unbearable, it is felt when bearing weight or during the movement of dorsiflexion of the foot, that is, bringing the toes up and stretching the fascia. The pain is in the heel region, but in severe cases it can go down to the toes.
First phase: at the beginning of the pain, the symptoms tend to decrease after a few minutes of starting training in athletes. Adults or older people report that the worst moments are waking up or after having been sitting for a long time, with time after starting to walk the pain decreases until it disappears.
Second phase: the pain increases in intensity and takes longer to subside, it takes half an hour to pass when getting out of bed or at the beginning of training, so starting to walk and doing sports becomes increasingly difficult. Walking down stairs is often difficult as the foot is dorsiflexed thereby stretching the plantar fascia.
In a sitting or lying position the symptoms are not felt. There is edema formation in the calcaneus. The pain leads to an unbalanced footing posture that can cause back or neck pain.
Diagnosis of plantar fasciitis
The professional who handles the case would collect the patient’s history, in search of the symptoms, press the area with his finger, evaluate the movement, sensitivity and also the length of the triceps surae muscle (calf). Next, check for any anatomical abnormalities such as flat feet, pronation, or varus.
In the differential diagnosis, other conditions that can give similar results must be taken into account, such as calcaneal spurs, calcaneal bursitis, entrapment of the abductor nerve of the fifth finger, gout (if the pain is bilateral) and a fracture.
The tests that are carried out are the X- ray to rule out fractures, tests for diseases such as rheumatic gout, and the electromyogram, which highlights the possible entrapment of a nerve. But the tests cannot replace the clinical examination by the doctor.
Which specialists should I see to heal from plantar fasciitis?
To cure or treat plantar fasciitis you can go to the following specialists:
- Podiatrist: Podiatry is a branch of medicine that specializes in problems or disorders that affect the foot. They are the first people you should go to when you start with the symptoms of plantar fasciitis
- Physiotherapists: Physiotherapists are trained to evaluate plantar fasciitis and design a treatment plan adapted to the characteristics of each patient. We have techniques and methods that help reduce/disappear the symptoms generated by plantar fasciitis.
What is the relationship between plantar fasciitis, calcaneal spur and other alterations?
The pain that is perceived in the sole of the foot is typical of plantar fasciitis, but this symptom also appears in other dysfunctions of the foot. Therefore, plantar fasciitis can be related to or confused with other types of injuries, some of them are the following:
The heel spur and plantar fasciitis
The heel spur is a bony growth that forms on the heel (calcaneus). This bony formation has a hook shape, the pain in the heel is generated due to the soft tissues that dig into the spur.
Many believe that the calcaneal spur causes plantar fasciitis, but in reality, plantar fasciitis ends up generating the spur. This bone forms in response to the tension generated by the fascia on the bone (this is one of its causes).
Morton’s neuroma and plantar fasciitis
Morton’s neuroma is inflammation of the nerves between the toes, mainly between the 3rd and 4th toes (sometimes between the 2nd and 3rd). This inflammation causes pain in the sole of the foot, right where the neuroma is, but it also generates sensitivity changes (tingling, numbness in the area), a symptom that plantar fasciitis does not present.
It can be confused with plantar fasciitis if a good evaluation is not performed.
Metatarsalgia and plantar fascia
Metatarsalgia is pain that occurs at the level of the metatarsals of the foot, the pain is located on the sole of the foot very close to the toes. This pain increases with walking, prolonged standing, running, and wearing tight-fitting shoes.
Its symptoms are very similar to those of plantar fasciitis, but the pain is localized (the pain is where the injury is), in addition to that, there is also the presence of tingling in the toes.
With a good evaluation, both pathologies can be differentiated.
Tarsal tunnel syndrome and plantar fasciitis
Tarsal tunnel syndrome is equivalent to carpal tunnel syndrome, but in the ankle. It appears due to compression of the tibial nerve at the level of the flexor retinaculum.
This syndrome generates pain (especially when standing for a long time and when walking) and a burning sensation and tingling in the sole of the foot and in the inner area of the ankle.
Treatment of plantar fasciitis
In some cases, if plantar fasciitis is not treated or treated correctly; mild pain can become a chronic problem. Having foot pain can change the way you walk. These involuntary changes can put stress on other parts of the body and cause knee pain, hip pain, and back pain, so the problem should be treated as soon as possible.
Plantar fasciitis, like tendinitis, needs to be addressed and treated as soon as possible because if it becomes chronic it can take several months to heal.
Each person’s body responds to plantar fasciitis treatment differently, and recovery times may vary. First of all, it is essential to stop sports activity during plantar fasciitis as it can aggravate the situation.
One treatment for fasciitis can be an orthosis, which is a device that can be inserted into any pair of shoes and can often relieve pain and help reverse the damage and onset of plantar fasciitis. They do this by adding support to the heel and helping to distribute weight during movement.
The use of a silicone heel to soften and protect the support on the ground relieves pain but is not curative. At night, the foot is kept in a plantar flexed position, so the plantar fascia and the triceps surae (calf) remain shortened, causing the patient to experience acute pain in the morning, which is why some specialists recommend a splint overnight to keep the foot dorsiflexed. During the day, you should perform the gastrocnemius and soleus stretch , because the retraction of these muscles is one of the causes of inflammation.
More invasive procedures for the treatment of plantar fasciitis are generally pursued only after other treatments have failed to produce favorable results. Corticosteroid injections to deliver medication into the injured fascia to reduce pain.
However, this treatment can weaken the plantar fascia and cause damage. Also, shock wave therapy is a treatment where sound waves are transmitted through damaged tissues in order to stimulate the damaged tissue and promote healing.
Plantar fasciitis exercises you can do at home
For the treatment of plantar fasciitis at home you can do the following:
- Self-massage of the plantar fascia: We will perform a massage to release the existing tension in the fascia and the muscles located on the sole of the foot.
- Ball self-massage: A ball is an excellent tool to help us perform a good plantar fascia massage. This massage seeks to reduce the stretch exerted by the weight of the body on the heel and the metatarsal heads (which stretches the plantar fascia). It also decreases the tension of the foot muscles.
- Mobilization of the tibial nerve: Compression of this nerve is known as tarsal tunnel syndrome and can cause pain and tingling along the nerve.
6 exercises, stretches and self-massages for plantar fasciitis
In this infographic we will show you 6 effective exercises, stretches and self-massages for the resolution of plantar fasciitis. For a more detailed explanation, we invite you to click on the image to be directed to an article where each exercise is explained.
When should plantar fasciitis be operated on? What is the operation for plantar fasciitis?
Surgery for plantar fasciitis is rarely performed because conservative treatment works in 90% of cases. The option of surgery is only considered when the patient has been treated with different conservative treatments and the symptoms do not diminish.
Surgery for plantar fasciitis involves making a longitudinal incision in the plantar fascia to decrease stress on the heel and relieve symptoms. The operation takes a few weeks to recover and requires physiotherapy sessions.
Plantar fasciitis surgery does not always achieve perfect results and symptoms can return after a while.
Prevent plantar fasciitis
It is important to prevent recurrence, as fasciitis is often caused by anatomical abnormalities: pes valgus, varus or pronation. For this reason, a custom insole is recommended to correct foot support.
Prevention of plantar fasciitis is crucial. There are many options to help prevent the onset of this disease, and keep it from coming back. One of the most important is to maintain a healthy weight to reduce stress on the plantar fascia. Also, shoes are very important, and they should be snug and provide sufficient cushioning, support throughout the heel, arch, and ball of the foot so that weight is evenly distributed throughout the foot. Try to avoid walking barefoot on hard surfaces and replace old shoes before putting them on, especially shoes used for running or exercise.
In exercise, start slowly and ease into new routines to avoid sudden or excessive stress on tissues. Lastly, keep your calf muscles and the tissue in your feet stretched. Greater flexibility in the tissues makes them less susceptible to damage.
Plantar Fasciitis Overview
- Plantar fasciitis is inflammation of the fascia that causes pain in the heel and along the bottom of the foot. It can be due to various causes such as overload, retraction of the Achilles tendon or mechanical stress.
- Plantar fasciitis is a moderate or endurable pain that is especially noticeable in the morning, when putting the foot on the ground, which evolves into an excruciating pain, like burning.
- The physiotherapist with the history, the clinical study and the symptoms will diagnose plantar fasciitis.
- Treatment should be done as soon as possible so that it does not become chronic. It consists of ending the inflammation through physiotherapy.