Plantar Fasciitis is the most common foot complaint and the main cause of heel pain, heel spurs and also arch pain. Millions of people suffer from Plantar Fasciitis, especially the over 50's. Fortunately for 80-90% of Plantar Fasciitis sufferers there are some very effective treatment solutions available.
Plantar Fasciitis (pronounced "plantar fash-eee-eye-tiss") means litterally "inflammation of the plantar fascia". Plantar Fasciitis is also called "Policeman's Heel". Plantar Fasciitis is often associated with calcaneal spurs (heel spurs).
Plantar Fasciitis usually presents itself as a sharp pain, experienced at the underside or front of the heel bone. Often the pain is worse with your first steps when getting out of bed in the morning. For most people Plantar Fasciitis pain is more severe following periods of inactivity or rest, when getting up. After a short while the sharp pain subsides, turning into a dull ache. In the morning, stiffness and swelling in the heel area may be present.
The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel this after (not during) exercise and walking. Most people will put up with heel pain for at least 6 weeks before seeking (self)treatment, information and/or advice.
If Plantar Fasciitis is left untreated, it may become a chronic condition and treatment will become far more difficult. Also, Plantar Fasciitis sufferers tend to avoid putting weight on the sore heel and will try to walk on the forefoot in order to avoid pressure on the heel. With this abnormal walking pattern one could easily develop problems in the knees, hips or back.
The Plantar Fascia is a thick, fibrous band of connective tissue that runs from the heel bone (calcaneus) along the sole of the foot like a fan, being attached at its other end to the base of each of the toes. It is a tough and resilient ligament structure that performs a critical function during walking and running.
The Plantar Fascia acts as a 'bowstring' connecting the ball of the foot to the heel. It forms the longitudinal arch of the foot and helps to lift the heel off the ground to prepare the foot for the 'take-off' (propulsive) phase of the gait cycle. During walking, at the moment the heel begins to lift off the ground, the Plantar Fascia endures tension that is around twice our body weight. The Plantar Fascia also act as a natural shock-absorber during walking and running.
Causes of Plantar Fasciitis:
Plantar Fasciitis is Latin for inflammation of the Plantar Fascia. This inflammation occurs at the point where the fascia attaches to the calcaneus (also known as the heel bone).
So what causes the Plantar Fascia to become inflamed? There are a number of various reasons for this to occur. For example, you are more likely to develop Plantar Fasciitis, if you are over 50 years old, if you're overweight, or pregnant, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you do a lot of walking or running for exercise (overuse injury). And if you have tight calf muscles (which a lot of people have) you're also more likely to develop Plantar Fasciitis.
Research has shown, however, that the number 1. cause for Plantar Fasciitis is over-pronation (or fallen arches).
Over-pronation of the feet is very common, at least half of the population has this problem, but most people don't realise they have this condition! Over-pronation simply means that the feet and ankles roll inwards too much during walking and that the arches collapse. With age, most people tend to over-pronate. However, this condition is not uncommon in children and teenagers, as well as athletes.
When the arch collapses the two outside points of the bow (being the heel and ball of the foot) are being placed farther away from each other. This puts repetitive stress on the Plantar Fascia. The attachment of the fascia into the heel bone is a tiny area of tissue, compared to the wide attachment area to the toes. Therefore, the constant excess pulling on the fascia will do damage to the weakest attachment point.
Over time irritation occurs at the heel bone, followed by inflammation and micro-tearing of the plantar fascia tissue. Sometimes swelling is present. If the pulling continues the heel bone will 'respond' and a bony growth will develop on the front of the heel bone. This is referred to as a 'heel spur'. Interestingly, the heel spur itself doesn't cause any pain, but the inflamed tissue around it does.
Plantar Fasciitis Treatment options:
Fortunately, most cases of Plantar Fasciitis can be treated effectively at home. Firstly, you need to refrain from activities that cause pain such as long walks, running, sports and standing for long periods. Rest allows any swelling, inflammation and/or pain to subside.
Applying ice (or a heat pack) to the heel area and using anti-inflammatory pain killers like Advil or Nurofen (both contain ibuprofen) will provide immediate pain relief.
However, long term, effective treatment of Plantar Fasciitis consists of a simple program of daily stretching exercises, combined with wearing an orthotic to support the arches.
Gentle stretching of the Plantar Fascia, the Achilles tendon and the calf muscles will all help making your feet and a lot more flexible, which in turn will help reduce the exessive pulling of the Plantar Fascia. Do the stretches fist thing in the morning and avoid walking barefoot on hard floors and tiles. Instead, slip on a pair of shoes with an orthotic inside them. Repeat the exercises (especially the calf stretches) a few times during the day.
You can find the complete Plantar Fasciitis stretching exercise program here. Or talk to your physiotherapist or podiatrist about specific exercises. Sometimes practitioners will prescribe a night splint, designed to gently stretch the fascia during the night.
With the combination of daily exercises and orthotics you will see a major improvement within a few weeks. If you are overweight, it is recommended to lose some weight as this will reduce the strain on your feet.
In cases where the pain persists, or is severe, Plantar Fasciitis can be treated with a cortisone-steroid injection into the heel. However, this is only a short term fix and the pain will return within 3 months. A newer treatment for Plantar Fasciitis (instituted prior to surgery) is electrocorporeal shock wave therapy. In this procedure, an instrument administers pulses of energy (shock waves) to your heel to relieve pain.
Surgery for Plantar Fasciitis is rarely required, unless all other treatments have failed to relieve the pain. Surgical procedures include removing a portion of the Plantar Fascia.
Plantar Fasciitis and Orthotics:
Research in America, Europe and Australia has clearly proven that wearing an orthotic insole is the best way to treat Plantar Fasciitis, especially when combined with daily exercises. However, it must be noted that this treatment regime is mostly effective for people who have started to notice heel pain recently (i.e. no longer than 6-8 weeks ago)l or for people who only suffer mild Plantar Fasciitis pain.
The reason an orthotic works is simple: the cause of Plantar Fasciitis is the constant pulling of the "bowstring" under the foot, because of the lowering of the arches. Orthotics prop the arches back up, thereby reducing the excessive tension on the plantar fascia.
With less tension on the plantar fascia, the damage to ligament can be reversed. The tissue is allowed to heal faster and repair the micro-tearing, which has occurred at the heel bone attachment.
There are different types of orthotics, including custom-made ones from a Podiatrist. However, not everyone will need a custom-made device. Nowadays, good supportive and inexpensive orthotics are available from retailers and specialty websites. The main factor is support, more so than cushioning. So don't buy a soft, spongy or gel footbed, but rather an insole with a high arch, made of reasonably firm materials.
Tips for preventing Plantar Fasciitis:
Correcting some of the pre-disposing factors will ensure Plantar Fasciitis doesn't re-occur, for example:
1. maintain a healthy weight: loose some weight, as this will reduce the physical load placed on the Plantar Fascia during walking
2. wear good quality, supportive shoes: i.e. shoes with a strong heel counter and with good flexibility in the front of the shoe (that allows the toes to bend back easily and naturally). A good shoe will help stabilise the heel and ankle joints during walking and running.
Don't wear completely flat shoes. A raised heel reduces the tension in the plantar fascia.
3. try to avoid walking barefoot on hard surfaces (including hard sand on the beach)
4. always stretch your calf muscles before exercising (walking, running or sports) first. Greater flexibility in the tissue makes them less susceptible to damage.