When the plantar fascia (a band of tissue connecting the heel bone to the base of the toes) swells or becomes irritated, a condition known as plantar fasciitis may develop. It usually manifests as a sharp, stabbing pain near the heel area, especially during the initial steps in the morning or after prolonged inactivity. This condition is a common foot complaint that affects athletes, runners, and individuals who spend long hours on their feet.
Heel pain is the primary symptom of plantar fasciitis. You may feel this pain upon waking up or after periods of rest. Other symptoms include:
Plantar fasciitis occurs from repetitive strain, tearing, or overuse of the fascia tissues. Activities that involve prolonged standing, walking, or running can lead to excessive stress on the bottom of your foot, resulting in inflammation and injury.
Foot mechanics can also contribute to plantar fasciitis. Individuals with flat feet (overpronation) or high arches may experience an imbalance in foot alignment, leading to increased pressure on the heel bone.
Your orthopaedic specialist will first discuss your symptoms and other factors, such as your activity level. They will also ask you about the duration and intensity of your heel pain. Your doctor will then perform a physical examination to identify any signs of inflammation, tenderness, or swelling in the affected foot. In some cases, imaging tests may be necessary to rule out other potential causes of foot pain, such as bone spurs or stress fractures.
The treatment of plantar fasciitis primarily depends on the severity of the condition.
Nonsurgical interventions are usually the first line of treatment for plantar fasciitis. They may include:
Rest and Ice: Rest your feet and avoid activities that exacerbate pain, such as running or jumping. You may also use ice packs appropriately to reduce swelling.
Physiotherapy: Your physiotherapist will design exercise programmes, provide manual therapy, and employ specialised modalities to alleviate plantar fascia pain and improve the strength and stability of your lower leg muscles and ankle.
Medications: Oral medications (NSAIDs) and pain relievers can help reduce discomfort and inflammation.
Orthotic: Custom-made orthotics, such as shoe inserts or arch supports, help absorb impact better during physical activity and take pressure off the plantar fascia.
Night Splints: Your foot and ankle doctor may suggest temporarily wearing night splints while you are asleep to stretch the plantar fascia and keep it flexed.
Injections: Injecting anti-inflammatory steroid medications into the plantar fascia can temporarily relieve pain.
Shockwave Therapy: This procedure stimulates plantar fascia regeneration using special pressure waves that may help to stimulate the production of collagen and promote tissue healing.
However, if non-surgical treatments do not provide sufficient relief, doctors will then recommend surgery. This may include:
Plantar Fascia Release: This procedure may be an option if heel pain persists despite having normal range of motion in the ankle. It involves partially cutting the fascia ligament to loosen the tension. This may be done via an open incision or endoscopically.
Gastrocnemius Recession: This procedure aims to lengthen one of two muscles in the calf. By doing so, your surgeon can relieve strain and tightness of the plantar fascia and improve foot and ankle mobility.
You may reduce your risk of developing plantar fasciitis by following these tips:
Wear Supportive Shoes: Choosing footwear with adequate arch support and cushioning reduces tension in the plantar fascia, especially if you have flat feet or high arches.
Maintain a Healthy Weight: Keeping an ideal weight can reduce strain on your feet and promote better foot arch alignment.
Gradual Increase in Physical Activity: Gradual increases in your activity level allow your body to adjust and prevent overuse injuries, especially when starting a new exercise programme.
Stretch and Strengthen: Regularly stretch and strengthen your feet and calves to maintain flexibility of the plantar fascia.
Avoid Excessive Standing or Walking on Hard Surfaces: Refrain from activities that place excessive stress on your feet, such as prolonged standing, walking, or running over hard surfaces. Take regular breaks and wear appropriate footwear when performing these activities.
Plantar fasciitis, if not treated, may cause chronic heel pain and discomfort. It may also change your gait pattern, and in turn cause problems in other areas of your lower limbs.
Another potential complication of plantar fasciitis is the development of bony growths on the heel bone (heel spurs), due to inflammation and stress in the plantar fascia over time.
Seeking early and appropriate treatment will go a long way in ensuring a quick and sustainable recovery.