Have you ever had nagging heel pain which you could not seem to shake off? Is the pain recurring and you’re waking up every morning with a stabbing pain in your heel? Don’t worry, you’re not alone! This is one of the most common complaints we see in our office. At this point, you probably have already Googled your way into a rabbit hole and seen the term “plantar fasciitis” multiple times. Fact: 1 out of 10 people suffer from planter fasciitis.
So now, the big question is, what is plantar fasciitis and how did I get it. Plantar fascia is a thick band of connective tissue that courses from your heel bone to the toes (Figure 1). It functions to support the arch when walking and prevents the arch from collapsing more than “normal.” This thick band elongates during the weight-bearing portion of the gait. Every time you walk and put weight on your foot, your arch collapses, which elongates the plantar fascia. When there is no weight on the foot, the plantar fascia returns to resting length. Now you could imagine the load that is put on our feet daily during the repetitive stretching and relaxing of the plantar fascia.
Figure 1. Plantar fascia anatomy
What causes plantar fasciitis?
The repetitive stress we place on the plantar fascia may cause micro tears and inflammation near the heel bone which is where you feel the pain.
What are some of the symptoms?
Symptoms include sharp heel pain after you get out of bed in the morning and after sitting down for some period of time. However, both instance improve after short periods of walking and stretching. You may also feel pain throughout the day.
Pain usually occurs first thing in the morning or after sitting for long periods of time because you have not placed any load to the plantar fascia. This allows it the “relax” and “shorten”. The first step you take after this “relaxation” period, painfully elongates the plantar fascia causing symptoms.
What are the risk factors?
There is a textbook answer and my experience answer. I have seen all types of patients experience plantar fasciitis regardless of body type, foot type, shoe gear, activity level and/or age. I had this when I was 16 and in good shape!
How do you treat plantar fasciitis?
It is an inflammatory condition caused by increased stress. Therefore, we typically start treatment with anti-inflammatories, which may be oral or local steroid injections. Also, RICE (rest, ice, compression, and elevation) may provide additional relief. However, this alone does not decrease the stress or change any bad biomechanics in the foot. Arch supports may be beneficial as they support the arch during gait. This prevents the arch from collapsing resulting in decreasing the stress placed on the plantar fascia.
In addition, stretching of the Achilles tendon and plantar fascia is the mainstay of treatment. Do you ever wonder why your pain went away after walking for a short period of time in the morning? It is because you are actively stretching the plantar fascia when walking. Other conservative options include regenerative therapy, immobilization, shockwave therapy, and more.
Luckily, conservative options are successful for 85% of the patients. The other 15% may be offered surgical intervention.
What does surgery entail?
The goal of the surgical procedure is to elongate the plantar fascia. Sounds simple? (Figure 2.) There are several options to accomplish this: endoscopic technique vs. open release. A small portion of the plantar fascia is released, which releases the tension, and the gap is later filled in with scar tissue which elongates the fascia. Some surgeons may add on procedures such as Achilles tendon lengthening, spur debridement, nerve release, and etc. Post-operative course varies per provider; however, most can be weight-bearing soon after surgery.
What are some other differential diagnoses?
Muscle belly strain
Soft tissue mass
As you can see there are plenty of treatment options conservatively and if they fail surgical options are available. Ideally, treatment should start early and often to overcome this nagging problem.
Until next time…
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