Everything You Need to Know About Plantar Fasciitis

Plantar Fasciitis is one of the most common symptoms every Orthopedic Surgeons receive from an outpatient complaint. It is an inflammation, which is characterized by pain and stiffness, in the heel and in the bottom of the foot. This often causes severe pain while moving or walking leading to patient’s inability and self-restraining from moving the foot itself.

Plantar fascia is the thick fibrous band of tissue that runs along the bottom of the foot. It connects the heels by fanning out and directly attaching to the ball of the foot and at the base of the toes. The plantar fascia, itself, serves as the shock-absorbing “bowstring” within the arch of the foot.

The medial part of the attachment of the plantar fascia to the toes is the most commonly injured area.  Inflammation in this area is due to a constant increase in the tension of the “bowstring” for a longer period of time. This results to swelling of the tissue and subsequent sensation of pain.



Symptoms of Plantar Fasciitis

The most remarkable and worth of attention symptom is heel pain particularly upon waking up in the morning. Many patients suffer difficulty in trying to take the first step in the morning.  Others also present with pain after resting the foot.

The pain usually moves from the heel to the middle part of the foot radiating to the sole. The degree of pain progresses gradually from mild to severe.

Causes Plantar Fasciitis

The plantar fascia lengthens and dwindles as the foot moves. If there is persistent stretching of the fascia beyond its normal length resulting to increase in tension, it causes tears and irritation in the fascia. This subsequently leads to painful inflammation or plantar fasciitis.

Plantar fasciitis has no gender predilection. Anybody can develop plantar fasciitis. But studies show it occurs more commonly is women. It is also often diagnosed in family members with arthritis and diabetes mellitus.

Certain daily activities cause plantar fasciitis including walking, running, standing and dancing specifically when using flat shoes or tight shoes for a longer period of time.

Other factors that can contribute to plantar fasciitis include being overweight, as it increases the tension of the plantar fascia. Improper shoes, for instance, wearing-high heeled or thin-soled without or lacks arch support or shock absorption capacity of the foot, can irritate the soles of the foot leading to inflammation.

Diagnosis of Plantar Fasciitis

For every medical practitioner, the diagnosis of plantar fasciitis is basically based on three important findings from the patient history, risk factors and physical examinations.

In the patient history, investigations are noted on the onset of pain of the foot such as the date (in days, months or years) when the pain has started.  Timing of the pain, for instance, if the pain occurs when walking, at rest, or just show up anytime, is very important and should not be missed in taking the history to delineate other possible diagnosis. The severity of pain should be assessed as well. This can be gauged from 0 – 10 as the latter is the most painful – the most severe pain has been felt. Specific location of the pain is salient in diagnosing plantar fasciitis as other location of pain in the sole of the foot suggests other pain sources and possible diagnosis. Radiation of the pain from its origin of pain is also important to check since pain due to plantar fasciitis do not usually radiate to other parts of the foot. Aggravating and alleviating factors contributing to the development of the pain are also important to note during history taking to be able to come up with the proper diagnosis of plantar fasciitis.

Risk factors to note on when diagnosing the disorder are the shape of the foot and the presence of any discrepancy of the leg lengths. Activities that are possibly related to daily routine and work should also be investigated on. This includes military personnel, restaurant food servers and those who are exposed to prolonged standing and walking. Aside from that, a sedentary lifestyle often leads to increase body mass index or obesity which is another factor to consider since being overweight requires more pressure for each foot arch to support the heavy weight of the body during standing up, walking or even just doing simple tasks.

On physical examination of the foot, upon entering the clinic, a patient tends not to put pressure or step using the affected foot. Most patients used to have someone to help him walk or walk with crutches. These are some of the first noticeable features that every medical practitioner suspects the diagnosis of plantar fasciitis.

Furthermore, palpation of the affected foot elicits tenderness in the mid-part of the sole. Stretching the tip of the toes which produce pain in the sole of the foot is suggestive of plantar fasciitis.

Once the diagnosis of plantar fasciitis has been noted, a confirmatory test is done but not necessary.  A confirmatory X-ray of the affected foot can be done and will show stress fracture.

Treatment Options for Plantar Fasciitis

Treatments for plantar fasciitis are divided into two; non-medical and medical approaches.

Non-medical treatment or the more commonly known conservative treatment is always the first approach. The simplest way is include modifying or altering the offending factor which causing the pain or irritation in the area. For instance, if the plantar fasciitis is due to the use of tightly fitting shoes, changing footwear is the best thing to do. Once the cause of pain has been modified, applying ice to the affected part of the sole of the foot is the next to do.  It would also relieve the pain faster if the area has been massaged always.

Medical treatment includes giving non-steroidal anti-inflammatory drugs such as diclofenac and ibuprofen. This is to alleviate the pain by its analgesic property and the inflammation or swelling of the affected area, by its anti-inflammatory mechanism.

However, if the condition worsened after six or more months of both medical and non-medical treatment, surgical treatment is considered.

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