An image of a foot affected by plantar fasciitis (click to zoom)
Plantar fasciitis is a disorder that affects the connective tissue in the arch of your feet, called the plantar fascia. The disorder causes pain in your heel and along the bottom of your foot.
Most individuals afflicted with this condition experience their most severe pain while taking their first steps of the day.
Plantar fasciitis treatment may include rest, pain relief treatments, wearing a night splint and stretching exercises.
Causes
The plantar fascia is a thick bowstring shaped band of tissue that extends across the bottom of your foot. It connects the heel bone and the area just behind the toes (known as the metatarsal area).
The role of the plantar fascia is to support the arch of your foot. It also absorbs shocks transmitted from the ground due to the impacts while walking.
Although the fundamental cause of plantar fasciitis is far from clear in many cases, the proximate cause is known. It is due to the appearance of small tears in the plantar fascia.
The micro tearing of the plantar fascia eventually causes the development of inflammation and the condition known as plantar fasciitis.
Researchers believe that the trigger for the micro tearing is sometimes repeated pressure due to high impact activities like running. This would make plantar fasciitis one of the most commonly experienced repetitive stress injuries.
However, in other cases, the micro tearing of the plantar fascia can appear with no apparent cause.
Risk Factors
Risk factors for chronic cases include the following:
Extensive participation in sports or other recreational activities that require plenty of running, jumping or other high impact activities;
Wearing old and worn out shoes that do not provide sufficient arch support. The risk is even high if you wear such shoes while participating in high impact activity. Wearing such shoes increases the work that must be done by the plantar fascia in supporting the arches of the feet;
Standing for long periods at a time (as required in certain jobs);
Having flat feet (fallen arches or pes planus). Excessively high arches (pes cavus) also appear to increase the risk of developing the disease;
Being overweight, as this increases the shocks transmitted through the plantar fascia ligament by even simple activities such as walking;
Age is also a risk factor, as most cases tend to appear between the ages of 40 and 60; and
Having an abnormal gait pattern that places too much stress on the plantar fascia over time.
Symptoms Of Plantar Fasciitis
The main symptom is pain along the bottom of the foot. This is usually the most severe when taking the first steps of the day.
The pain tends to have the following patterns:
People with plantar fasciitis usually complain that the pain is at its worst during the first few steps of the day;
The pain can also worsen when resuming regular activity after a period of daytime rest;
It is usually aggravated by high impact exercise. However, it tends to worsen after the activity has been completed instead of during it.
A possible long term complication of plantar fasciitis is the development of disorders elsewhere in the body. For example, problems may appear in the knees and back. This is a result of the patient changing his gait pattern to avoid the unpleasant foot pain of the condition.
Plantar fasciitis is marked by its particularly unpleasant pain and the possible long term complications. As a result, we suggest seeing a doctor for a diagnosis if you are experiencing the above symptoms.
Diagnosis
To diagnose plantar fasciitis, your doctor will probably review your medical history and ask you questions about your symptoms. He or she may want to know what makes them worse or better, for example.
Your doctor may then need to palpate (examine by touch) the bottom of your foot. This will help him or her to understand the precise location of your foot pain.
That is usually all that is required. Imaging studies are usually unnecessary unless your doctor wants to rule out another condition with similar symptoms.
Treatment
To treat plantar fasciitis, most doctors will probably suggest a non-invasive home care plan such as described below. If this does not relieve the problem, progressively more invasive steps may be taken.
Home Based
Home based treatment of plantar fasciitis may include:
Resting the plantar fascia by avoiding high impact activities and allowing it to recover naturally;
Apply ice to the bottom of your foot every 2-3 hours for periods of around 20 minutes. Alternatively use a cold compress. This will help to reduce pain and swelling;
For additional pain control, use an OTC pain killer such as Tylenol. If you need to control both pain and inflammation, consider using non steroidal anti inflammatory drugs instead. Ibuprofen, Naproxen and aspirin are good examples.
Wearing a night splint such as the BioSkin Night Splint or the Darco Body Armor Night Splint when sleeping. These products will keep the plantar fascia properly stretched out and will reduce the pain you experience in the morning;
Alternatively, a foot sleeve like the DCS Plantar Fasciitis Sleeve can help to ease the symptoms. It too can keep the plantar fascia stretched and reduce morning pain;
Some ankle braces such as the BioSkin Trilok have features to combat plantar fasciitis, if it is related to fallen arches;
Changing your footwear, if fallen arches is a contributing factor. Try using shoes with better arch support;
If your plantar fasciitis is related to poor arch support, consider using shoe inserts with your existing footwear. These may be purchased off the shelf or can be custom made;
If you are overweight, enrollment in a weight loss program will reduce the stress on the plantar fascia; and
Stretching or strengthening physical therapy exercises. These are intended to strengthen your foot muscles and improve the flexibility of calf muscles. We suggest 5 of these exercises here;
Non Invasive Physician Treatment
If the above steps do not relieve the pain, consult with your doctor. He or she may be able to administer the following treatments:
Cortisone injections into the plantar fascia to aggressively combat inflammation there. However, care needs to be taken with this treatment. If over used, it could damage or rupture the plantar fascia.
Doctors can also apply shock wave therapy by directing sound waves at the painful area in order to speed healing;
A new treatment option involves first inserting a needle-like instrument into the injured plantar fascia tissue. Ultrasonic energy is then used to vibrate the instrument rapidly to break up the damaged tissue. Finally, the damaged tissue is then suctioned out of the plantar fascia.
Surgical Options
In the past, heel spurs were thought to be a contributory factor to plantar fasciitis. Surgery was done to remove heel spurs as part of the treatment.
However, heel spurs can exist in many patients with no plantar fasciitis signs. This surgical treatment is no longer pursued widely.
A second surgical treatment option is to detach the plantar fascia from the heel bone. This is considered a highly invasive treatment, however. Doctors will usually consider it only when all else has failed and the patient is in extreme pain.
For more discussion of potential treatments for plantar fasciitis, please read this post.
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Prevention
If you would like to avoid experiencing plantar fasciitis pain in the first place, consider the following steps;
Reduce your amount of high impact exercise or sports activity. Consider cross training by substituting low impact activities like swimming or cycling instead;
Maintain a healthy body weight;
Use shoes with high quality arch support, particularly when undertaking high impact activities; and
Avoid using old or worn out shoes with poor arch support.
The Mueller Sports Medicine Arch Support uses compression to help relieve plantar fasciitis pain. The targeted upward compression is achieved using a soft gel pad. Other notable features of the Arch Support are: An included adjustable strap to help you achieve a custom fit with the correct balance between support and comfort; No natural rubber…
The Darco Body Armor Night Splint is the only night splint that actively engages the windlass mechanism of the foot, resulting in a specific and sustained stretch to the plantar fascia, and a sustained low load stretch to the flexor tendons, Achilles tendon and calf muscles. The traction strap allows for minimal ambulation.
Darco DCS Plantar Fasciitis Sleeve – a continuous wave of compression provides support to the plantar fascia. The Darco DCS Plantar Fasciitis Sleeve is woven to be anatomically correct. Wave compression technology on the plantar surface of the foot provides a sustained stretch on the plantar fascia. The DCSâ„¢ PF gives relief from the discomfort associated with plantar fasciitis by promoting circulation, reducing edema and foot fatigue and reducing morning foot pain.
The Mueller Sports Medicine EASYfit® Kinesiology Tape applications are designed to be simple to use and can help relieve certain overuse injuries. Three (3) applications in each package for the knee, shoulder, foot/arch, calf/ankle/neck and waist/back applications. Six (6) applications in each package for the X & Y pattern applications.
Oppo Medical Gel Arch Pads provide valuable support to fallen arches and prevent painful feet after spending prolonged periods standing, walking or running. They absorb shock, improve overall foot comfort and ward off a host of more serious foot problems.
Oppo Medical Heel Cushions have an extra soft green gel insert at the medial (inner) surface of your heel to ease pressure and pain caused by plantar fasciitis or heel spurs. A special low profile cushion provides support, shock absorption and comfort. Indications Plantar fasciitis; Heel pain; Pressure redistribution; Shock absorption.
The Mueller Sports Medicine Kinesiology Tape – 30m Continuous Roll features Mueller’s revolutionary wave adhesive pattern for effective rehabilitation of sore, weak or damaged muscles or joints.
Mueller Sports Medicine Kinesiology Tape – 5m Continuous Roll is a great choice for rapid rehabilitation for your sore, weak or injured muscles and joints. With its revolutionary wave pattern adhesive, it will lift your skin as you move to optimize your circulation and promote early recovery to full health. You cn wear it for up to 5 days at a time. Made from pure high grade cotton. Latex free, highly elastic and breathable in order to perform its “lifting” function more effectively.
The Mueller Sports Medicine Kinesiology Tape – I-Strip Roll will help you to treat ligament and other soft tissue injuries as well as repetitive stress injuries such as carpal tunnel.
The One Size Fits All Mueller Sports Medicine PFTape® System uses a patented technology to relieve the pain of plantar fasciitis, leaving you to continue enjoying your normal lifestyle. It directly controls plantar stress by stabilizing your foot and restricting both supination and pronation movements. Straightforward to apply – no cutting or modification needed. 7 applications per pack, each giving up to 24 hours of pain relief.
Use Kinesio Pre-Cut Application tapes for treatment of various repetitive stress injuries. As the pieces are pre-cut, you do not need to cut them before putting them on, which simplifies application.
Oppo Medical Silicone Heel Cushions have heel cups to help correct the alignment of your body and stabilize your heel. The heel cushions have a wedge-shape to reduce pressure on the Achilles tendon. They also have an extra soft green gel that helps mitigate pain and pressure on the most sensitive part of the plantar…
Kinesio Tex Classic successfully treats a variety of orthopaedic, neuromuscular, neurological and medical conditions. It provides fast and effective pain relief and support for muscle aches and pains and directly targets the fascia (skin layers) and muscle tissue to treat the cause of muscle inflammation and pain.
The versatile Bio Skin TriLok delivers precision unloading to both medial and lateral structures. Its FootLokâ„¢ Strap supports and protects the lateral ligaments, the peroneal tendons, the plantar fascia or the posterior tibial tendon. You can wear the TriLok with almost any type of footwear or even barefoot if you prefer.
Oppo Medical Waffle Comfort Arch Supports help to reduce and absorb the impact of shocks to the feet. They also help to provide heel cushioning and relieve pressure to the heel. Waffle Comfort Arch Supports also have a top cloth for additional comfort and moisture transfer. Oppo Medical Waffle Comfort Arch Supports – Indications Heel…