- Plantar fasciitis is inflammation of the fascia on the sole of the foot.
- The main symptom is pain along the inside of the foot, which extends into the sole.
- It is often felt in conjunction with a spasm in a small muscle inside the arch of the foot.
- The pain is often worse on rising, like when getting out of bed, or standing or walking after resting, sitting or driving.
- Treatment is complex and involves rest, anti-inflammatory drugs, biomechanically correct orthotic devices, Physiotherapy or Shock wave therapy, or Night splints. Occasionally Hydrocortisone injections and surgery may be needed, in VERY severe non-responsive cases.
What is plantar fasciitis?
The Plantar fascia is a band of tissue that starts in the heel and runs forward to the toes, It is one of three support structures of the arch of the foot, and plays a vital role in supporting the foot, as well as in toeing off correctly.
This fascia is connective tissue which forms membranous layers of varying thickness in all regions of the body. All fascia join into the next level, so the plantar fascia, joins (lightly) to the Achilles tendon, and so on. It is a dynamic structure that assists in support and movement in the whole body. Plantar fasciitis occurs when this layer in the sole of the foot becomes inflamed.
It becomes evident by pain along the inner border of the sole of the foot.
What causes plantar fasciitis?
The cause is thought to be inflammation possibly due to excessive stretching (overuse, either sudden overload or a gradual increase in load) of the plantar fascia between the two areas of the foot to which it is attached. The actual inflammatory process is now being questioned and the current understanding is that it is a fasciopathy, which is different from true inflammation
Plantar fasciitis, heelspur pain, Inferior calcaneal bursitis and calcaneal enthesopathy (the enthesis is where the plantar fascia has its origin against the heel bone calcanues) are all similar conditions. However these conditions must be differentiated from each other, despite their treatments being very similar
It may be associated with heel spurs, but this is not certain and the finding of a heel spur on X-ray may be purely coincidental, since many people have bony spurs with no problems with plantar fasciitis. A heel spur is a bony outgrowth from the weight-bearing part of the heel.
The inflammation can be part of a wider condition such as rheumatoid arthritis.
What are the symptoms and signs of plantar fasciitis?
The main problem is pain beneath the heel on standing or walking, most often felt after resting or on waking. The pain extends towards the inside of the foot and into the sole. This can be crippling in some people and makes walking almost impossible.
When the inflammation is part of something like rheumatoid arthritis, both feet can be affected.
When the foot is examined, there is marked tenderness over the inner side of the foot and particularly over the weight-bearing part of the heel. When dorsiflexing the big toe, a band of tissue can be felt running from the heel to the big toe, this is the plantar fascia and the pain can be anywhere from the heel to the toe. In some cases it can be felt just behind the lesser toes as well.
X-rays usually do not show any abnormality, although a heel spur may be seen in some people. The presence of a spur is often incidental and often not the cause of the pain
How is plantar fasciitis treated?
The most important part of plantar fasciitis treatment is to educate the patient that despite treatment it can be a resistant condition and that resolution takes time. In fact, there are some people who believe that you never cure fasciitis, but you can only manage it to be pain free. Diagnosis may require a specialist examination, using ultrasound visualization.
The treatment is divided into two parts
The first step is to treat the symptom with physiotherapy, rest, ice, electrical modalities like ultrasound, mobilization, and stretching the fascia of the foot and calf. This can all help.
This treatment can be augmented by shock wave therapy, cortisone injection (some pundits are arguing against this), non-steroidal anti-inflammatory drugs (again those who believe it isn’t a true inflammatory condition argue against the use of NSAIDs), night splints, crutches and walking boots.
The use of in-shoe biomechanically correct orthotic devices has been shown in the literature to assist in the healing and resolution of plantar fasciitis. Orthotics achieve the following:
1. Support the arch and decrease the stretch in the plantar fascia
2. Correct the alignment of the heel which causes the arch to collapse
3. Correct the toe-off mechanism which is an essential part of
the function of the plantar fascia
4. Raise the heel which reduces the tension in the plantar fascia and Achilles
tendon which some believe are joined by fascial bands around the heel bone
5. Cushion the heel.
If the fasciitis is part of a widespread inflammatory condition such as rheumatoid arthritis, then treating the arthritis will help the fasciitis.
When to see your doctor, or podiatrist
If you have pain in the sole of your foot, which is not getting better, then see your doctor, or podiatrist. The most common mistake patients make is thinking it will get better by itself. The longer you have plantar fasciitis, the longer it takes to treat. If the symptoms are not resolving or gone completely in 2-3 weeks, get help as soon as possible.
Reviewed by Dr Sirk Loots, orthopaedic surgeon.
Revised by Sean J Pincus, Podiatrist NHDPod(SA) BSc Hons (Brighton), September 2010.
Other related articles:
Non-steroidal anti-inflammatory drugs (NSAIDs)
COX-2 specific inhibitors
South African Podiatry Association (SAPA)