What is Plantar Fasciitis?

(Larson, 2022)

Plantar fasciitis (literally, inflammation or irritation of the plantar fascia) is a common cause of heel pain. The plantar fascia is a strong band of tissue that runs along the bottom of the foot and connects the heel bone to the toes, supporting the foot’s arch. Plantar fasciitis begins when tears develop in the fascia at sites of repetitive stress, which becomes highly inflamed and painful. The condition forms most commonly around the medial calcaneal tuberosity (the inner part of the heel), which is an important structure for maintaining the foot’s biomechanics (position and movement), providing arch support and absorbing shock. In the general adult population, this is, by far, the most common cause of heel pain, and especially for those who walk or stand on their feet for long periods.

Plantar fasciitis is a pernicious condition that often recurs despite treatment, and can be difficult to fully eliminate; it is multi-causal, which means there are challenges in identifying and eliminating the primary causative factors.

Causes of Plantar Fasciitis:

Overuse is the biggest risk factor for developing plantar fasciitis. When the plantar fascia is repeatedly stressed or strained, it can develop microscopic tears, causing pain. Causes include:

• Foot structure: If you have flat feet, also known as overly flexible feet or pes planus, you have a higher risk of plantar fasciitis. On the other hand, if you have feet known for their excessively high arches or pes cavus, you also have an increased risk.
• Muscular tension: Tension in the calf or muscles of the lower leg (gastrocnemius, soleus, tibialis posterior) can strain the fascia.
• Work: In fact, any work that involves a lot of standing or walking on a hard surface can be implicated, including factory work, standing in a kitchen, walking for work, standing bagging or at checkouts.
• Age and activity: Older adults are more prone to developing it, as are athletes (particularly runners) and, if you carry a little extra weight, you’ll be at greater risk too, as this places a burden on your feet.

Symptoms of Plantar Fasciitis:

The main sign of plantar fasciitis is the dull pain in the bottom of the foot near the heel that has become a trademark of the condition. It usually shows up first thing in the morning when you first step out of bed, and after being confined to a chair or standing up for long stretches of time. Pain that spans the heel in the first days of plantar fasciitis will become more confined to a single point on the bottom of the foot at the base of the heel. In its latter stages, you might limp or otherwise avoid putting your weight on the heel.

Treatment Options:
Non-surgical Treatments:

Non-surgical treatments work for about 90 per cent of people, though it can take up to 10 months to feel better. Treatments include:

• Rest and Ice: Resting the foot and applying ice can reduce inflammation and pain.
• Medications: Over-the-counter anti-inflammatory medications like ibuprofen can help reduce swelling and pain.
• Stretching exercises: Stretching the calf muscles and plantar fascia helps alleviate pain and tension.
• Physical Therapy: Physical therapists are sometimes recommended to walk, run and jump On the other hand, fitness therapists can recommend exercise programs to strengthen and stretch muscles and carry out massage and other specialised therapies such as hydrotherapy.

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• Comfortable footwear: Shoes with cushioning and good support, or night splints to keep the fascia stretched while sleeping, can help relieve symptoms.
• Cortisone injections: Typically, cortisone is injected into the fascia to reduce swelling. But cortisone injections have a tendency of thinning out the fascia, and too many injections can lead to tearing the fascia.
• Extracorporeal shock wave therapy (ESWT): non-invasive treatment with shock waves for inducing healing.

Surgical Treatments:

And if non-surgical treatments fail after a year or so it might be sensible to contemplate surgery, which could include:

• Gastrocnemius recession: surgical lengthening of the calf muscle can relax tension on the plantar fascia.
• Plantar fascia release: A partial severance of the fascia to temper the tension and relieve the pain – the most advanced with possible nerve damage.

Outlook and Prognosis:

Proper treatment will allow the majority of people to improve within a year. However, the recovery process can be slow and many athletes find it very frustrating. Only a small number of patients with plantar fasciitis require surgery. In people who do not have their condition treated, plantar fasciitis often results in long-term problems, such as changes in the mechanical way they walk, which can create problems in other joints, like the knee and hip.

References:

Larson, J. (2022, February 24). What to know about plantar fasciitis. Healthline. Retrieved May 28, 2022, from https://www.healthline.com/health/plantar-fasciitis

Author: Krupa Patel, Under the guidance of Sanklap Thakur

Sanklap graduated Registered Massage Therapy program at Vancouver Career College in 2022. Prior to studying RMT, Sanklap graduated in Bachelor of Ayurvedic Medicine and Surgery (BAMS) Program at Baba Farid University of Health Sciences. He pursued Masters in Hospital Administration (MHA) from Rajeev Gandhi University of Health Sciences Bangalore, India. He has almost 7 years of experience in health care working amongst patients and also in the hospital administration. Through years of postsecondary education, he has gained a vast knowledge of human anatomy, medical terminology, medicines, surgery and various diseases that helps him with creating the best treatment for his patients. With past experiences in sports (table tennis, basketball and cricket), he also understands what it takes to compete at a high level in sports. While in school he gained experience in working with patients with many kinds of injuries, chronic pain, joint disorders, neuromuscular disorders, elite athletes, and elderly patients. Throughout the program he has learned the benefits of being an RMT and how manual therapy plays an important role in overall health, wellness and helping people achieve their lifestyle goals. Sanklap uses a combination of Swedish, myofascial, stretching exercises, neuromuscular techniques, joint mobilizations, and trigger point release techniques to aid his patients in recovery from pain, injuries, surgery and more. He is constantly continuing to expand his repertoire of techniques to help provide better treatments.