What is Plantar Fasciitis?
Plantar Fasciitis’ name actually describes what it is: the plantar aspect of the foot means the bottom of the foot. Plantar is the opposite in this case of dorsal, like the dorsal fin of a dolphin. The fascia is a ligament in the sole of the foot that stretches from the heel to the toes.
If you feel the sole of the foot when it is relaxed it is soft. When you stretch your toes upwards and feel the sole of the foot it becomes firm as the plantar fascia is engaged. “Itis” is a Latin term for inflammation; the familiar appendicitis, tendinitis, bursitis all mean inflamed body parts and fasciitis is no exception. Therefore, plantar fasciitis is an inflamed plantar fascia. (pronounced fas (like fast)- see-eye-tiss). Plantar fasciitis is also called heel spur syndrome.
It is very common for people who suffer from plantar fasciitis to also have spurs on their heels where the inflamed, tight fascia has caused the formation of calcium deposits. This is often diagnosed by X-ray. Interestingly, the heel spur is not the source of the pain; it is the inflammation of the fascia where it is attached to the heel that actually hurts usually accompanied an inflammed bursa. Bursae are fluid-filled sacs located where some ligaments and tendons attach to bone. These bursae fill with fluid overnight and during periods of rest and aches when first stepped on until it is deflated a bit by walking on it.
Symptoms of Plantar Fasciitis
Symptoms of plantar fasciitis are usually disturbing to those who suffer from it. One morning you step out of bed, out of the car, or out of a chair and an excruciating pain rips through your foot. You are shocked and alarmed but, after a few minutes or steps, the pain eases and goes away… until the next time. On occasion plantar fasciitis symptoms are less classic. Pain may occur in the sole or heel after being on the foot for a while or only when flat shoes are worn.
Causes of Plantar Fasciitis
Plantar fasciitis is usually caused by straining of the plantar fascia. This occurs by wearing shoes like flip flops that give the foot little to no support. It can also occur due to weight gain, flat foot, increased activity, overuse and arthritic and orthopedic conditions such as:
- Accessory navicular
- Posterior tibial tendon dysfunction
- Rheumatoid arthritis
Plantar fasciitis usually occurs in people with Achilles tightness. This is why many people feel better when they wear a slight heel vs flats. It has been argued that the plantar fascia is a continuation of the Achilles tendon. Together the Achilles tendon and plantar fascia allow for the foot to propel the body forward during the walking cycle.
Plantar Fasciitis Treatment
The treatment of plantar fasciitis is a two-part event. The symptoms first need to be relieved and then measures need to be taken to prevent the reappearance of symptoms. In order to relieve symptoms, the inflammation of the fascia needs to be addressed:
Anti-inflammatories are usually recommended. Ice, NSAIDS (like Motrin® or prescription medications), steroid injections and oral steroid medications are all anti-inflammatory and often offer immediate if temporary relief. Inserts and Insoles offering support of the foot and therefore relief of tension on the plantar fascia are key during the initial phase of treatment and to prevent reoccurrence.
Over-the-counter insoles can be helpful but the use of custom orthotics or insoles is preferred and often covered by insurance.
Stretching the Achilles tendon and fascia is also important. Night splints are often dispensed (and also covered by insurance) for this purpose.
Compression sleeves and cushions for the arch and heel can be helpful as well. Massage and other physical therapy modalities like ultrasound and EPAT can be very helpful in the treatment of plantar fasciitis. EPAT is a stronger form of ultrasound and has been found to be very effective for plantar fasciitis. It does not require anesthetic and is completely non invasive.
Surgery may be necessary if all else fails. The use of a camera makes the partial release of the plantar fascia a minimally invasive procedure with a rapid recovery time.
Supportive shoe gear and supportive orthotics should be a lifelong practice in order to prevent the reoccurrence of the plantar fascia stretching of the Achilles and plantar fascia.
For more information on plantar fasciitis or to schedule an appointment with one of our specialists, contact Essex Union Podiatry today.