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PlantarFasciitis – Symptoms, Causes and Treatment (by a Medical Doctor)
Plantar fasciitis is one of the most common causes of heel pain in many individuals around the world. It is commonly seen in runners.
Plantar Fasciitis – Symptoms, Causes and Treatment (by a Medical Doctor)
Plantar fasciitis is a painful condition which occurs due to inflammation of your plantar fascia.
Plantar fascia is the thick band of tissue that runs across the bottom of your foot connecting your heel bone to the toes.
Your plantar fascia is like a bowstring which supports the arch of your foot.
It absorbs shock when you walk. This bowstring can get inflamed due to too much tension, leading to plantar fasciitis.
Plantar fasciitis can lead to stabbing pain once you wake up and walk in the morning. The pain is typically felt in the bottom of your foot near the heel. Pain is worst when you take the first steps once you wake up.
When you continue to walk, your pain may reduce, but it can return after long periods of standing or when you get up after sitting for some time. Heel pain worsen after exercise, but not during the exercise. If you suffer from these symptoms, you are probably suffering from Plantar fasciitis.
There are certain complications which can arise from plantar fasciitis. Ignoring it may give rise to chronic heel pain which hinders regular activities. If you change the way you walk, in order to relieve your pain, it can lead to many hip, back, knee and foot problems in future.
What are the causes of Plantar fasciitis?
Cause remain unclear in many patients with Plantar fasciitis. If the stress or tension on your plantar fascia is too much, small tears can occur.
If stretching and tearing occur repeatedly, it can irritate your plantar fascia causing inflammation.
There are some factors which can increase your risk of developing Plantar fasciitis;
Your age – Plantar fasciitis is more common in 40 – 60-year age group.
Obesity or over weight individuals – excess weight can put extra tension on your plantar fascia.
Mechanics of your foot – If you have flat feet or a high arch or if you have an abnormal walking pattern, the weight distribution can be affected. This can put added tension on your plantar fascia leading to inflammation.
Certain exercises – Activities such as long-distance running, aerobic dances/ Zumba and ballet dancing, put a lot of tension on your heel and plantar fascia.
Certain occupations – teachers, factory workers and those who spend most of their time standing and walking on hard surfaces, can damage the plantar fascia causing tears.
Diagnosis is done based on your history and physical examination. Your doctor will assess the severity of pain and areas of tenderness. Imaging tests like X-Ray or MRI may be ordered to exclude certain conditions like fractures causing pain.
Sometimes plantar fasciitis may associate with a bone spur sticking out from your heel bone, which can be seen from X-Ray, but most of the time, it is not the reason for your heel pain.
There are many therapeutic options for plantar fasciitis. However, first line treatment would be trying medications. Pain relievers such as Naproxen (Aleve) and Ibuprofen (Advil) will help to ease the pain and inflammation caused by plantar fasciitis.
You can combine the oral medications with stretching and strengthening exercises.
Physical therapy – Your physical therapist can teach you several exercises to stretch your plantar fascia and Achilles tendon along with strengthening the muscles of your lower leg and foot.
Special devices can be used to relieve symptoms, such as:
Night splints – a splint can be worn to stretch your calf muscles and the arch of your foot while sleeping. The splint will hold your plantar fascia and the Achilles tendon in a lengthened position overnight, while it promotes stretching.
Sometimes athletic taping can be applied to support the bottom of your feet.
Orthotics – custom-fitted arch supports may be prescribed by your doctor to help even distribution of pressure to your feet.
Usually these conservative measures will help to relive symptoms of plantar fasciitis. However, for some of you, these measures may not work. Then your doctor will possibly recommend:
Steroid injections – Temporary pain relief can be provided by injecting steroids to the tender area. However, these should not be given too often as steroids can weaken your plantar fascia causing it to rupture.
Platelet rich plasma (PRP) injections – PRP which is obtained from your own blood can be injected to the tender region using ultra sound imaging. PRP promotes tissue healing.
Extra corporeal shockwave therapy – Sound waves will be directed to the tender area to stimulate healing.
Ultrasonic tissue repair – A needle like probe will be guarded into the damaged plantar fascia by using ultra sound imaging. The probe tip vibrates rapidly due to ultra sound energy which breaks the damaged tissue. It is then suctioned out.
Surgery – Surgery is the last option if your pain is severe and does not respond to other treatments. The plantar fascia will be detached from your heel bone. It can be done through a small incision with local anesthesia or as an open procedure.
How long does it take for plantar fasciitis to go away?
Most people recover in several months with conservative treatment, which includes resting, stretching and keeping ice packs over the painful region.
Best exercises for plantar fasciitis include stretching of your plantar fascia, Achilles tendon and calf muscles regularly.
Never walk bare foot as it can worsen the symptoms.
Avoid activities that put a lot of tension on your plantar fascia such as long distance running and aerobic dances. Instead try low impact sports like swimming or bicycling. Even walking and jogging for long periods might worsen your symptoms.
Choose supportive shoes and shoes with a low to moderate heel, thick sole with good arch support. Extra cushioning in your shoe will help ease the pain. You can get your shoes custom made by fitted arch supports. This can help even distribution of pressure to your feet while walking and standing for long periods. Custom- fitted arch supports take your foot mechanics into consideration that helps to relive symptoms.
Avoid wearing worn-out athletic shoes, as they will not adequately support or cushion your feet while running. Replace your old athletic shoes before they are worn out.
Select shoes with shock absorbing pod cushions and curving insoles which gives good arch and heel support. It needs extra rigidity in the sole and cushioning in the mid foot to prevent impact on your heel.
The shoe that has a thick midsole or rocker bottom is the ideal shoe. In addition to comfort, you should choose a shoe that provides the least impact when your foot strikes on a hard surface.
Running, especially long- distance running puts excessive stress and tension on your plantar fascia. This can cause further tears or even rupture if you are not careful. Therefore, if you have symptoms of plantar fasciitis, it is better to avoid running.
If you are an individual who desires to run daily, you can potentially continue to run with plantar fasciitis as long as your pain is mild (if the pain score remains below 5, on a scale from 0 to 10) and settles the next day.
Many runners continue to run with symptoms however, if your pain continues to worsen stop and rest.
The final advice is if you really want to run, run with caution. As running with plantar fasciitis has not been studied widely, we cannot ensure that there won’t be any long- term complications.
https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846
https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/diagnosis-treatment/drc-20354851
https://www.kinetic-revolution.com/can-you-run-with-plantar-fasciitis/
https://www.healthline.com/health/best-shoes-for-plantar-fasciitis#what-to-look-for
by Coach P. Hoyal, NAIA Track & Field All American
Dr. Sharmila Samaranayake
By Dr. Sharmila Samaranayake
Dr. Sharmila Samaranayake (MBBS, DCH) passed with honors from Medical faculty of Colombo, along with post graduate qualifications of Diploma in Child Health and Diploma in Child psychology. She is a Medical officer attached to National hospital of Sri Lanka. Dr. Sharmila is an experienced freelancer and has many publications in many Sri Lankan magazines and Newspapers related to Health, fitness and beauty.
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