PLANTAR FASCIITIS | PLANTAR FASCIITIS |
PLANTAR FASCIITIS | PLANTAR FASCIITIS |
CONDITION: PLANTAR FASCIITIS
Plantar Fasciitis is a common foot condition characterized by inflammation of the plantar fascia, a band of tissue supporting the arch of the foot. It often results in heel pain, especially with the first steps in the morning or after prolonged inactivity. If left untreated, plantar fasciitis can lead to chronic pain, limited mobility, and decreased quality of life. While it can be persistent, plantar fasciitis is typically manageable with rest, stretching exercises, proper footwear, corticosteroid injection and other treatments aimed at reducing pain and inflammation
SYMPTOMS
Heel Pain: Sharp or stabbing pain, often near the heel, worsened with the first steps in the morning, after rest or prolonged sitting.
Stiffness: Pain and stiffness that improve with activity but may return after extended use.
Tenderness: Sensitivity on the underside of the foot, particularly near the heel.
Swelling: Mild swelling or a feeling of tightness along the bottom of the foot.
CAUSES & RISK FACTORS
Overuse or Excessive Stress:
Activities like running, dancing, or prolonged standing place repetitive strain on the fascia.
Biomechanical Issues:
Flat Feet (Pes Planus): Reduces arch support, overloading the plantar fascia.
High Arches (Pes Cavus): Poor shock absorption places excessive tension on the fascia.
Abnormal Gait Patterns: Uneven weight distribution stresses the fascia.
Muscle Tightness or Weakness:
Tight Achilles tendon or calf muscles increase stress on the fascia.
Weak intrinsic foot muscles reduce foot stability.
Age-Related Changes:
Most common between 40–60 years as tissue elasticity decreases.
Occupational Risks:
Jobs requiring prolonged standing (e.g., factory workers, teachers).
Other Risk Factors:
Sudden increase in physical activity.
Poor footwear (e.g., flip-flops, unsupportive flats).
Overweight/obesity increases foot pressure.
DIAGNOSIS & TESTS
WINDLASS TEST
Clinical Examination:
Palpation reveals tenderness at the medial heel or along the fascia.
Pain with dorsiflexion of the toes (Windlass test).
Imaging Studies (If Needed):
X-rays: May show a heel spur (bony growth at the attachment point).
Ultrasound or MRI: Identifies thickened fascia, inflammation, or small tears.
MANAGEMENT & TREATMENT
A. Conservative Care (First Line):
TO REDUCE INFLAMMATION
1. Rest and Activity Modification
Rest does not mean sit on the couch and stop walking. Rest means give your arch a break! You can do this by avoiding high impact activities, barefoot exercise, or using overly flexible shoes.
2. Compression
Compression socks or sleeves offer gentle pressure and support to the arch, reducing strain on the plantar fascia during activity or rest.
Compression also improves circulation, minimizes swelling and pain around the plantar fascia.
3. Icing
Use a frozen water bottle with arch/roller massage under the foot for 10–15 minutes, 3–4 times daily.
4. NSAIDs:
Anti-inflammatories such as ibuprofen, Celebrex, Mobic, Motrin, Aleve, and Advil helps reduce pain and inflammation.
Topical NSAIDs may be used for localized effects.
A. Conservative Care (First Line):
TO IMPROVE STABILITY
1. Footwear
See my list of stability shoes below. A stability shoe will help minimize stress on the plantar fascia and reduce excessive pronation. Once stabilized, your foot will be able to function without abnormal stress on the plantar fascia causing pain and inflammation.
2. Stretching/Strengthening Exercises (Examples):
Plantar Fascia Stretch: Sit down, cross one leg over the other, and pull your toes toward your shin for 15–30 seconds.
Calf Stretch Against a Wall: Place hands on a wall, keep the back leg straight, and push the heel toward the floor.
3. Custom molded orthotics:
If you have exhausted conservative measures as described above, you may need additional stability in the form of a custom molded orthotic. Similar to a stability shoe, a custom molded orthotic with improve foot function by reducing excessive pronation and stress on the plantar fascia.
4. Taping
Taping improves stability in plantar fasciitis by supporting the arch and limiting excessive foot movements, which helps maintain proper alignment and mechanics during activities. Although tape does not last forever it can simulate how your foot will function with improved stability from a shoe, brace or custom orthotic.
5. Physical Therapy Modalities:
Manual therapy, taping techniques, or stretching programs to improve alignment and flexibility.
B. Medical Interventions:
1. Steroid Injections:
Used sparingly to manage severe pain but may weaken the fascia with repeated use.
2. Night Splints:
Keeps the foot and toes dorsiflexed to stretch the fascia overnight.
C. Surgical Options (Rare, Last Resort):
Fasciotomy: Partial release of the plantar fascia in severe, unresponsive cases.
Post-surgical recovery may take several months.
PREVENTION
Daily Stretching: Maintain flexibility in the fascia and Achilles tendon.
Wearing the Right Shoes: Use supportive footwear with shock-absorbing soles.
Gradual Activity Changes: Avoid sudden increases in exercise intensity or duration.
Strengthening Exercises: Build stability in the foot and ankle.
Maintain Healthy Weight: Reduces the stress placed on your feet.
PROGNOSIS
Short-Term Prognosis
Acute phase (first few weeks to months): Initial treatment focuses on reducing pain and inflammation. This includes rest, stretching exercises, icing, orthotics, and over-the-counter medications like NSAIDs. Many patients see improvement in symptoms within 6–12 weeks.
Mid-Term Prognosis
3–6 months: With ongoing conservative treatment, most patients experience substantial relief. Adherence to physical therapy, proper footwear, and activity modifications are key to recovery.
Long-Term Prognosis
After 6 months: Approximately 90% of patients recover fully without requiring surgical intervention. Persistent cases may benefit from advanced treatments like corticosteroid injections, shockwave therapy, or platelet-rich plasma (PRP).
Chronic or Refractory Cases
If symptoms persist beyond a year despite conservative measures, additional interventions (e.g., surgery or minimally invasive procedures) may be considered. These cases are less common and may have contributing factors such as severe foot biomechanics, obesity, or occupational strain
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SHOE ARTICLES:
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Plantar fasciitis is a manageable condition that responds well to early intervention and a multifaceted treatment approach. By addressing risk factors, adopting preventative measures, and staying consistent with recommended therapies, individuals can achieve significant pain relief and regain full mobility. For persistent or severe cases, consult a podiatrist to explore advanced treatment options and develop a personalized care plan. With proper management, most people can return to their regular activities and maintain long-term foot health.