What exactly is plantar fasciitis?
From a histological point of view, plantar fasciitis is a degenerative process of the fascia tissue, producing microtears and inflammation due to overstretching or overloading of the fascia.
In the foot is the plantar fascia, a flat, thick, fibrous band of relatively inelastic tissue that runs from one end of the sole of the foot to the other, from the heel to the metatarsal area.
The plantar fascia plays an important biomechanical role in walking, together with other structures of the foot it maintains the plantar arch, while absorbing shock during walking and protecting the metatarsal area, thus preventing excessive dorsal flexion of the toes. When walking, tension in the plantar fascia is concentrated near its origin in the calcaneus.
Is this problem common?
It is very common in adults of all ages, especially in people who do not play sports, it usually appears after the age of 45, although it is also seen in young patients who play sports regularly and in athletes who run long races on an uneven surface.
In the case of runners, many cases are diagnosed in autumn due to the change of habits, in the summer season many make a break in their activity and when they return in September and October to demanding routines fasciitis occurs.
Recent studies indicate that 1 in 10 people may suffer a plantar fasciitis problem in their lifetime, and it can occur in one or both feet simultaneously.
CAUSES of plantar fasciitis:
- Inappropriate footwear for the activity we are going to develop.
- A badly healed sprain produces a pain when the foot rests on the foot that generates a change in the footprint.
- Lack of information on how and when to stretch the muscles of the legs, since by defect or excess of exercise, the musculature can be affected.
- Muscle overload, which can cause muscle shortening and contractures, resulting in stress on the sole of the foot.
- Rheumatic diseases can also cause pain in the heel area.
You are more likely to develop plantar fasciitis if:
- You are obese or have significant weight gain in a short time.
- Run long distances on uneven surfaces
- Has problems with the arch of the foot
- Wear shoes with poor arch support or soft soles
- Tight Achilles tendon
- Changes its activities
SYMPTOMS of plantar fasciitis
The main symptom that many patients report is a sharp pain in the inner heel area, being more intense in the first steps of the morning when getting out of bed.
The reason? The fascia at rest is relaxed, but when walking starts, a stronger traction is generated, which produces pain that is reduced when walking for a while. There is also mild swelling, tenderness and redness on the underside of the heel.
This pain is also more intense:
- After standing or sitting for a while
- After an intense activity
- When climbing stairs
- When running or jumping when practicing sports.
The pain may appear slowly and progressively or suddenly after intense activity.
In people who regularly do sports, in the initial stages of fasciitis, pain occurs in the mornings and also after doing sports, in the meantime the sports activity can be done. If left untreated, there is a possibility of aggravating the problem, limiting the patient’s normal daily activities.
If you answer yes to one or more questions, you may be suffering from plantar fasciitis:
- Does your heel hurt more when you get out of bed in the morning?
- Do you feel that the most sensitive part of the foot is the heel?
- Does the heel pain seem to get better after a few minutes of standing or walking?
- Does one or both heels hurt a lot after walking or running?
- Does your heel pain seem to get worse when you stand up after sitting for a long time?
- Does the heel pain seem more severe after many hours of standing?
- Does the pain in the heel of your foot cause you to limp?
- Have you been experiencing this type of pain, which comes and goes, for a long time?
- With age have you experienced episodes of heel pain?
- Did the feet start to hurt after gaining weight to the point of being overweight?
What is the difference between plantar fasciitis and heel spurs?
The most important difference is that the spur is a calcification that occurs at the level of the heel bone or calcaneus and requires specific treatments.
When the ligament has become excessively elongated, the body itself forms calcium deposits as an attempt by the body to provide additional support to the overstretched ligament.
For this reason, radiological tests are performed in which it is studied if there is calcification, in case there is no calcification, it would be plantar fasciitis. In both cases the goal should be to reduce tension in the plantar fascia to eliminate pain. Therefore, it is very important to start as soon as possible to relieve tension on the plantar fascia in order not to aggravate the problem and thus obtain good results in a short period of time.
Although heel spurs may coincide with plantar fasciitis, plantar fasciitis is not usually the cause of the pain. Studies indicate that only one-third of people with a heel spur also have symptoms of plantar fasciitis, whereas two-thirds of the population with a heel spur have no symptoms.
Is plantar fasciitis more common in men or women?
It has been seen that in the non-athlete population the rate of cases is higher in women or in people with spondyloarthropathies. While in the athlete population the cases among men and women are similar.
When talking about fasciitis in women, there is a relationship between the length of the posterior leg musculature and plantar fasciitis. Wearing high-heeled shoes causes progressive shortening of the posterior leg musculature and increases the likelihood of developing plantar fasciitis.
How to treat plantar fasciitis?
Inflammation of the fascia causes pain but this inflammation is produced by increased stress on the plantar fascia due to, for example, foot type, foot strike, musculoskeletal alterations, etc.
When only the acute phase of fasciitis is treated, the inflammation is reduced and the patient temporarily improves until it recurs again because the increased stress on the fascia has not been reduced.
For diagnosis, a physical examination and clinical history are performed. This information is used to determine the stage of the patient’s plantar fasciitis. Then, the podiatrist performs a study of the footprint in which it is assessed whether the inflammation suffered by the fascia is related to the way of stepping.
Is there a chance of suffering plantar fasciitis again?
If the root problem of the first fasciitis is not corrected, it may recur or even become chronic.
Does the type of footprint have an influence on being more prone to plantar fasciitis?
Studies have shown that the shape of the footprint is one of the main causes of plantar fasciitis in people with a pronation tendency.
In the case of cavus feet, where the bridge is higher than normal and valgus feet that have a tendency to collapse inwards, there is a decrease in the support of the external lateral area, leaving the fascia in a situation of greater tension.
How long will I have pain?
In many cases, plantar fasciitis occurs due to injuries over time. Just as the condition has not developed suddenly, it will also need time to heal.
With treatment of the condition, the pain should subside within a few weeks, but it may take longer for it to disappear completely, from several months to a year.
Therefore, the prescribed treatment must be taken consistently.
What is the usual treatment for plantar fasciitis?
In patients with initial symptoms of plantar fasciitis, the foot should be rested and medication prescribed by the physician should be taken to reduce the inflammation caused by acute phase fasciitis. In addition to a combination of physiotherapy exercises.
The next step would be to visit a foot specialist to perform a tread study or gait study to assess the distribution of pressures and the relationship between the presenting symptoms. Based on the results of the studies, an orthopedic insole will be made under a plaster cast.
The custom-made insole aims to reduce stress on the plantar fascia, thus eliminating inflammation and pain.
Once the plantar fascia stops hurting, it is important to start physical activity progressively with footwear appropriate to the activity being performed.
It should be clarified that there are currently many “gait studies” that do not serve to treat fasciitis or other problems and only serve to advise on the type of shoe, as they do in sports stores.
Similarly, in some orthopedic clinics, gait studies are performed and preformed insoles are applied by an orthopedic technician, who is not qualified to make diagnoses or provide insoles.
Since its objective is only to manufacture an orthopedic product following the instructions of a specialist podiatrist, traumatologist or rehabilitation doctor.
Finally, it is important to remember that a correctly made custom-made orthopedic insole can significantly improve a patient’s quality of life, but a poorly made insole can cause new problems or aggravate existing ones.
If the insoles cause pain, they should be removed and the professional who made them should be consulted. Often, many centers do not have their own workshop to make modifications and must send them to the factory to make the corresponding changes.
At Clínica San Román we have our own workshop where we make custom-made insoles.
Minimally invasive surgery is used only in certain advanced cases of plantar fasciitis in which patients do not improve after several months of treatment.
Article prepared by Clínica San Román
Date of publication: 27-08-2018
Date of revision: 10-02-2020
