What does the plantar fascia consist of?
The plantar fascia is a fibrous soft-tissue band extending along the foot from the heel to the metatarsal region. Plantar fasciitis is the inflammation of this thick tissue band, known as fascia or aponeurosis, located on the plantar aspect of the foot.
Excessive stress on this part of the foot produces inflammation and pain around the plantar-medial aspect of the heel. The inflammation doesn’t present acutely; instead, it has a gradual onset. It can often be painful walking on the initial steps in the morning after waking up, and is also exacerbated following a period of physical activity, as opposed to during the activity.
The plantar fascia, or aponeurosis, has an important biomechanical function when walking. Along with other foot structures, it takes the bearing of maintaining the plantar arch, taking/absorbing the impact loads of the foot on the ground when walking, as well as protecting the metatarsal region.
Is plantar fasciitis a common problem?
Plantar fasciitis is often noted in adults but especially in women between 40-60 years old. Recent studies show that up to 1 in 10 people will suffer from this condition at some point in their life.
This condition should be treated promptly; otherwise, it may become chronic, greatly affecting daily activities and promoting the development of other problems in the knees, hips and back.
It is a very frequent condition, mainly in young inactive people that suddenly take up an activity or in those that are already active and simply increase their usual activity levels.
What symptoms can make us suspect of plantar fasciitis?
Overstressing this part of the foot produces inflammation and pain around the anteromedial aspect of the heel (insertion point of plantar fascia). The pain is more severe first thing in the morning or upon standing up after a period of prolonged rest. The reason for this phenomenon is that when we rest the fascia is also at ease and when we start to walk again it produces a strong traction on the fascia which after a while stretches and becomes more bearable. Nonetheless, the pain can worsen throughout the day.
In the initial stages of plantar fasciitis among sport people, the onset of pain occurs in the morning or after exercise. If not managed correctly, the condition may deteriorate and become chronic to the point that it limits the person’s daily life.
What’s the difference between plantar fasciitis and a heel spur?
The prime difference is the presence of a heel spur. A spur is a calcification that occurs at the level of the heel bone (calcaneus) and requires specific treatments. Such calcification is caused by repetitive and excessive strain on the plantar fascia insertion that causes micro trauma. Whenever a plain film X-ray demonstrates a calcification we are talking of a spur, and when it doesn’t show calcification we are talking of plantar fasciitis. Both share the same treatment aim: to reduce tension within the plantar fascia, thus relieving the inflammation and pain in the area.
Consequently it is imperative to recognise the condition early to decrease the strain and tension within the plantar fascia as soon as possible and prevent it from becoming chronic.
In what gender is plantar fasciitis more common?
Women that don’t regularly exercise and patients with spondyloarthropathies have a greater incidence of plantar fasciitis. However, in those that regularly exercise there’s an equal prevalence between genders.
When talking about plantar fasciitis in women there is a direct link between posterior leg muscle shortening (contracture) and plantar fasciitis. The long-term use of heeled footwear causes a progressive shortening of the posterior leg muscles that increases the probability of developing plantar fasciitis.
Women that suffer recurring episodes of plantar fasciitis and habitually wear high heels must remember the importance of reducing heel height progressively; otherwise, a sudden change in heel height can lead to Achilles tendonitis and even back pain.
How to resolve plantar fasciitis?
The greatest difficulty when trying to resolve plantar fasciitis once and for all is focusing on assessing the source (aetiology) of the problem.
Inflammation of the fascia causes pain but such inflammation is caused by the increase in stress at the plantar fascia due to, for instance, foot type, type of gait, musculoskeletal abnormalities, etc.
When considering plantar fasciitis in its acute phase only, the inflammation is reduced and the pain ceases but the patient only improves temporarily until symptoms recur because there hasn’t been a reduction in the increased strain over the plantar fascia.
Why does plantar fasciitis recur?
If one only treats the inflammation of the fascia without correcting or reducing the excess strain, the problem recurs and becomes chronic. Not only that but plantar fasciitis in its chronic stage becomes much more difficult to resolve.