What is Plantar Fasciitis?
Plantar fasciitis is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis.
What is the Plantar Fascia?
The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes. It has been reported that plantar fasciitis occurs in two million Americans a year and 10% of the population over a lifetime. It is commonly associated with long periods of weight bearing. Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is increased probability of knee pains, especially among runners.
The most common complaint is pain in the bottom of the heel, which is usually worse in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull ache that improves with rest.
Risk factors for plantar fasciitis include:
- Foot arch problems (both flat feet and high arches)
- Repetitive loading on the feet from long-distance running, especially running downhill or on uneven surfaces
- Sudden weight gain
- Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
- Shoes with poor arch support or soft soles
The diagnosis of plantar fasciitis is usually made by clinical examination alone.The clinical examination may include checking the patient’s feet and watching the patient stand and walk. The clinical examination will take under consideration a patient’s medical history, physical activity, foot pain symptoms and more. The doctor may decide to use Imaging studies like radiographs, diagnostic ultrasound and MRI.
An incidental finding associated with this condition is a heel spur, a small bony calcification, on the calcaneus heel bone, in which case it is the underlying condition, and not the spur itself, which produces the pain. The condition is responsible for the creation of the spur, the plantar fasciitis is not caused by the spur.
Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis. Some current studies suggest that plantar fasciitis isn’t actually inflamed plantar fascia, but merely an inflamed Flexor digitorum brevis muscle belly. Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.
Treatment options for plantar fasciitis include rest, massage therapy, stretching, weight loss, night splints, motion control running shoes, physical therapy, Cold therapy, orthotics, anti-inflammatory medications, injection of corticosteroids and surgery in refractory cases. As there is evidence that people’s footgear largely contributes to their foot problems, walking barefoot is beneficial. Also, in some cases, massaging of the inflamed location serves as a temporary relief for an extended period of time.