Plantar Fasciitis/Heel Pain: Symptoms, Causes, Risks, Complications, Diagnosis and Treatment

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Feet of a man who suffer from Plantar Fasciitis

1Overview

Foot pain is one of the most painful conditions because people use their feet often – standing, walking, and running. With foot pain, many daily activities will be affected.
One of the most common conditions affecting the foot is plantar fasciitis. It involves the inflammation of the thick band of tissue at the bottom of the foot.

The plantar fascia is the large and flat band of tissue called ligament that connects the heel bone to the toes. It acts as the support of the foot arch and once it gets strained, it becomes weak, irritated and swollen. The plantar fascia also acts as the foot’s shock absorber. The pain happens when one stands on the heel or while walking.
This is because the weight of the body is placed on the heels of the feet.

The condition is common among middle-aged individuals but it can still occur in young people if they use their feet a lot – nurses, athletes, soldiers, salesladies, and security officers, among others.

The pain is described as the stabbing pain that usually happens with the first few steps in the morning. As the individual moves more, the pain usually decreases but it can return at the end of the day after long periods of standing or sudden standing from sitting.

2Symptoms

The major complaint of people with plantar fasciitis is stiffness and pain in the bottom of the foot (heel). The pain develops slowly over time and it just affects one foot.
In some cases, however, it can also affect both feet.

The condition causes a stabbing pain in the heel area and it is worst in the first few steps in the morning upon waking up. In others, they feel the pain when standing for long periods or rising from sitting. Also, climbing the stairs can be very hard due to the stiffness of the heel.

3Causes

The cause of plantar fasciitis can be rooted in the wear and tear of the ligament in the heel of the foot. It’s caused by the straining of the ligament that supports the arch of the foot and acts as a shock absorber of the lower extremities.

When there is repeated and persistent strain on the ligament, it can lead to the formation of small tears, which can lead to pain and swelling.

4Risk Factors

Plantar fasciitis can occur without any obvious cause due to certain risk factors.
These include:

Age – Plantar fasciitis is common in middle adults, about the age of between 40 and 60 years old.

Poor foot mechanics – Having a high arc, being flat-footed and having an abnormal style of walking may increase the risk of having plantar fasciitis. This is due to the weight being distributed when one is walking or standing. When the weight is not evenly distributed, it puts pressure and strain on one foot.

Some types of exercise – Some fitness activities may put too much stress on the foot and heel. The activities include ballistic jumping, ballet dancing, long-distance running and aerobic dance.

Being overweight or obese – Being overweight or obese may put excess stress and pressure on the plantar fascia.

Occupations that involve prolonged standing or walking – Some occupations that require the workers to stand for long periods may also increase their risk of having plantar fasciitis. Factory workers, nurses, and teachers are the most commonly affected professionals.

5Complications

The complication of plantar fasciitis is the inability of the patient to participate in regular activities because of pain, swelling, and stiffness.

Plantar fasciitis needs treatment to prevent it from becoming chronic and persistent.
If left untreated, it may impair mobility and keep the person from getting exercise and moving around. In the long run, it can lead to knee, hip and back problems. Also, it may lead to other foot conditions that can affect one’s gait and ability to walk.

The other related complications include:

Plantar tears – In the long run, if plantar fasciitis is not treated, the inflammation, pressure, and stress of the plantar fascia can lead to small tears. Also, you may not be aware that these small tears could prolong and worsen the pain felt on foot. The number and size of these tears may eventually grow, making it more susceptible to debilitation and rupture.

Plantar fibromatosis – Plantar fibromatosis is a condition wherein slow-growing and benign nodules develop along the affected ligament. However, even though they are slow-growing, this may be followed by rapid a sudden growth, leading to pain and discomfort.

Plantar rupture – Plantar rupture happens if the plantar fasciitis is left untreated.
If the person who has the condition continues to engage in activities that put pressure and impact on the plantar fascia, it may rupture leading to intense pain, swelling, bruising and a large popping sound. This is an emergency condition and immediate medical attention is needed to prevent disability. The patient may use crutches for a long period until the fascia is repaired.

It is important to seek medical attention as soon as the symptoms to appear to prevent serious complications that can negatively impact one’s life. Athletes and those who are standing for long periods should avoid certain activities and provide rest to the feet now and then. Permanent disability is imminent if the condition is not taken seriously. Treatment is needed to ensure that the condition will improve and to prevent further damage to the muscle. 

6Diagnosis

The physician may conduct a medical history interview, focusing on the types of activities the person does and his or her occupation, and a complete physical examination.
The doctor will also ask questions about the past health like the history of illnesses and injuries, the symptoms like the type of pain being felt, the timing of pain (if it happens in the morning or throughout the day) and the location of pain.

Aside from this, a physical examination will also be conducted wherein the doctor will check for areas of swelling or tenderness in the foot. Then, imaging tests will also help confirm the diagnosis. They will also provide an idea of the severity of the condition.

Imaging tests

Normally, there is no need for tests but the doctor may recommend that you have an X-ray or magnetic resonance imaging (MRI). These tests will determine if the pain is not caused by other problems like a pinched nerve or a stress fracture.

In some cases, an X-ray can show a spur of bone that projects from the heel bone.
For decades, these spurs were blamed for heel pain and they are surgically removed. However, in many individuals with spurs, they experience no pain.

7Treatment

Most individuals have recovered from plantar fasciitis within a year. Here are the treatment options you can have:

Medicines

The medicines are used to relieve pain and swelling. Pain relievers are the commonly-prescribed medicines for plantar fasciitis. These include NSAIDs like ibuprofen and naproxen sodium.

Therapy

Stretching and strengthening exercises with special equipment may help provide relief from the symptoms, which include:

Using night splints –  The doctor or physical therapist may recommend using a splint while sleeping. The splint will allow the calf and arch of the foot to be stretched.

Physical therapy – This involves many exercises to help stretch the plantar fascia and Achilles tendon. Physical therapy helps strengthen the lower leg muscles, hence stabilizing the heel and the ankle.

Orthotics – The doctor can prescribe an arch support or orthotics to help in distributing the pressure on the feet equally and evenly.

Surgery and other procedures

Injections – In some cases, the doctor might recommend administering steroid injections into the affected area to relieve pain and swelling.

Surgery – Some people may need surgery to help detach the plantar fascia from the heel bone. This was usually the last resort when all other treatment options did not work.

Tenex procedure – The Tenex procedure is a minimally-invasive procedure that removes the plantar fascia scar tissue without the need for surgery.

Extracorporeal shock wave therapy – In this procedure, the sound waves are directed to the area of heel pain to trigger and stimulate healing. This option is normally used in chronic and persistent plantar fasciitis.

Lifestyle and home remedies

To help reduce inflammation and pain, here are some home remedies:

  • Maintain a healthy weight. If you’re overweight or obese, lose weight to reduce the stress on the plantar fascia.
  • Do not wear worn-out or old athletic shoes. Athletic shoes should be changed when they’re worn out. This is because, at some point, the shoes lose its purpose of providing support for the feet.
  • Choose supportive shoes like avoiding high heels and buying ones that have moderate heels that provide a better arch support and shock absorbency.
  • Change your sport if you can’t cope with the physical needs of the sport. You can shift to low impact activities and sport like bicycling, swimming and others, instead of jogging.
  • Apply a cold compress and apply it on the affected area for about 15 to 20 minutes several times daily.
  • Stretch the foot arch by performing home exercises.