What is Plantar Fasciitis?
Plantar fasciitis (which is pronounced “PLAN-ter-fash-ee-EYE-tus”) is a condition that causes heel pain and is, in fact, the most common cause of heel pain when it presents.
This disease is named after the plantar fascia, which is the flat band of tissue that has a very important job – connecting your heel bone to your toes, and therefore keeping your feet in working order! This is a ligament that actively supports your foot’s arch. However, when the plantar fascia is distressed, this can be the source of a lot of pain and anguish. If it’s strained, it can easily grow weak and become inflamed and swollen. Because of this, you’ll feel associated pain when standing or walking on a weakened and suffering platter fascia. Of course, this is a condition that can have a very debilitating effect on everyday life, as suddenly walking, standing and moving becomes a painful proposition. Because of this, it’s integral to seek help and support from a team of medical experts in order to provide yourself with pain relief and work towards healing.
This is an ailment that is quite common amongst middle-aged people, or individuals whose careers and everyday work requirements see them on their feet for long lengths of time. Plantar fasciitis can occur in just a single foot or in both.
Causes of Plantar Fasciitis
Our bodies are powerful machines, designed to function in amazing ways and under many different circumstances. However, they’re also susceptible to damage and distress, and when even a single part of our body is in pain, we feel the repercussions noticeably throughout our entire selves. Think of even a small wood splinter… though it may be tiny, if you find one lodged in your finger, it’ll frustrate you until you’re able to remove it!
The same can be said of ligaments throughout the body. These are extremely versatile bands that are made of tough yet flexible connective tissue. Their purpose is to connect two bones or cartilages together, creating a joint. Ligaments can be thought of as rubber bands, and are designed for versatility and flexibility in order to keep our joints strong, healthy, supple and able.
When ligaments are strained and push too far, it’s similar to that rubber band image – they can weaken, or in extreme circumstances, they can snap. Plantar fasciitis arises when the ligament that supports the arch of your foot is strained. It’s a painful image even to think about! Tiny tears can emerge in the ligament as a result of strain, which leads to even more issues within the ligament, creating an ugly cycle of pain and stress leading to more pain and stress.
There are a few common causes for plantar fasciitis. These causes include…
‘Excessive pronation’, which is the term used when feet roll inwards too far when walking
If a person has noticeably flat feet or high arches
Overweight people can often suffer from plantar fasciitis as a result of weight distribution issues
Badly fitting shoes which do not offer the support necessary
Achilles tendons that are tight and causing strain on the plantar fascia
Tight calf muscles
The good news is, when it comes to the areas in the foot which plantar fasciitis affects, the pain it leads to is easily identifiable and is not often confused with other issues. When a ligament is strained or experiencing tearing of any kind, it’s pretty obvious to the individual suffering as to the feeling and root cause of the issue.
Generally, people with plantar fasciitis will experience some form of pain when taking the first step after either a good night’s sleep or a long time sitting down. This pain may reduce as you continue to walk, as the joint gets less stiff and blood begins to flow once more. However, the pain may continue throughout the day, and often to a greater extent. One thing’s certain for those with plantar fasciitis – stairs are not a welcome proposition!
One way to check if you’re experiencing plantar fasciitis or a different problem is whether or not you experience pain in your foot at night. If so, you may be suffering from something different, including potential arthritis or a nerve problem. Keep an eye on your symptoms to identify when pain occurs in your foot, as this will help to rule out other ailments and identify the root cause of your issue.
How plantar fasciitis is diagnosed
It’s relatively simple to diagnose plantar fasciitis. Your doctor will be able to examine you as you stand or walk around, and will pair this visual examination with in-depth questions about your health history. These questions will include requests for information on any illnesses or injuries you may have experienced recently which may shed some light on your symptoms and areas of pain. They’ll also ask about the time of day where you experience this pain, and about the kind of physical activity, you’re engaging with on a regular basis.
In some cases, your doctor may deem it necessary to take an X-ray of the foot if they believe there may actually be an issue with its bones. Sometimes you may have a stress fracture in a bone without even realizing it, and it may present with similar symptoms as plantar fasciitis. An X-ray process will remove any doubt and leave you confident that you’re receiving the best treatment possible for your specific needs.
Plantar fasciitis treatments
Unfortunately, plantar fasciitis is not an issue that is treated the same from patient to patient, so you’ll need the help of a well-trained medical professional in order to know you’re being treated in the way your particular case requires.
However, there are a number of areas you can be active in with the goal of letting your foot recover…
Give your feet a break – reduce the number of activities that are going to cause stress or pressure on your feet, and limit the amount of time you spend walking or standing. Rest is extremely important in the treatment of plantar fasciitis, as the ligament needs time to recover and heal after the stress and damage it’s suffered. You may find you need to make changes to your everyday routine to implement more rest time, whether it’s at home or at the office. However, most work environments are supportive and understanding of health-related requirements for their employees, so an open discussion with your superior will help to create an environment where you can take the measures you need throughout your work day to provide yourself with pain relief.
Ice is an effective way to reduce the pain and minimize swelling. Applying ice to your heel may help to remove some of the pain you’re experiencing. This is something you can do throughout the day if you’ve had to stand on your feet for a number of hours – sit down, give yourself a rest and put some ice on your heel to encourage a reduction in the swelling and give your plantar fascia a break from the hard work.
Over the counter, pain relief medication is a practical and easily accessible tool. Pain relievers including ibuprofen or naproxen will be of most assistance. The good news is, these are commonly found, and so even if you’re traveling and forgot to bring other medications with you, you’ll always be able to access some pain relief through these simple and common tablets.
There are certain exercises you can do to encourage healing in your foot. Toe stretches, calf stretches and towel stretches are all useful tools in rebuilding your ligament’s strength without placing increased pressure on it. The best time to do these exercises is first thing in the morning. Towel stretches are executed by placing a rolled towel under the ball of your foot and pulling on both ends, creating a resistance that your foot needs to work against. These exercises help to stretch the ligaments in a non-damaging way and encourage muscle building, which in turn strengthens the ligament and reduces the risk of plantar fasciitis reoccurring. This is something a physiotherapist will be able to assist with, as well, so make an appointment to discuss your plantar fasciitis and ask them to show you the most effective exercise techniques which you can implement into a daily routine at home with no expert needed.
It’s also important to ensure you’re wearing shoes that provide you with reliable and healthy support. Shoes must have great arch support and also a cushioned sole. This provides a healthy supportive environment for your feet as you work them through everyday activity, and reduces the impact they feel from repetitive walking or standing up for too long without a break. Also, ladies – no more high heels. These only cause extreme tightness in the calf muscles which make the condition far worse. It’s also important to make sure your shoes are replaced regularly, so they’re not worn out. If your shoes begin to lose their strength, you need to replace them with a fresh pair to make sure your feet are getting the support they require throughout the stress and pressure of everyday movement, especially walking or standing on hard surfaces for an extensive period of time. There are specific shoes available on the markets that are marketed as plantar fasciitis shoes. These may be the right choice of purchase for you, but as long as you remember the principles of support required from your shoes, you can find a great pair that will provide you with optimal support.
What if these treatments don’t work?
If these DIY treatments do not provide assistance, your doctor may advise a splint to be worn at night. Other treatments include shots of medicine, such as steroids, into the heel to encourage growth in those areas.
Surgery is not a common requirement for people suffering from plantar fasciitis. This is a more extreme approach, which will only be suggested by a doctor after all other treatments have been attempted for between 6 and 12 months.
However, there may come a time when surgery is the best course of action for treating your plantar fasciitis. This is a decision your doctor will make after you’ve exhausted all other options without success.
Surgery to treat plantar fasciitis involves cutting a segment of the plantar fascia itself with the purpose of releasing tension and easing the ligament’s inflammation. A local anesthetic is often used in order to numb the area and reduce the pain felt throughout the procedure. This is a procedure that can be carried out either via open surgery or via endoscopic surgery, where instruments are inserted through smaller incisions compared to a full-scale surgery.
Firstly, the surgeon will begin by making an incision above the foot’s heel pad, which is where the thick sole skin meets the thin skin of the back of the heel. Your surgeon may also opt to make an incision on the bottom of the foot instead.
If this is done endoscopically, only a small incision will be needed on either side of the heel directly underneath the ankle bone. Next, the surgeon will detach the plantar fascia from the heel, making incisions to let the tension out and provide some relief for the plantar fascia.
Further steps can involve the smoothing of bone surface to give the plantar fascia space to heal with reduced tension. In some cases, the surgeon may also decide to remove a small part of the damaged tissue, creating more space and therefore assisting in the healing process as the plantar fascia recovers from the incisions.
The thickest part of the foot muscle, known as the abductor halluces, may also be freed in order to stop the nerves from becoming trapped as a side effect of the surgical procedure.
If you undergo open surgery rather than endoscopic, you will need to wear a non-weight-bearing cast for 2-3 weeks post surgery. This gives the tissue the time it needs to heal without placing weight on it which could threaten the healing process. If you put weight on your foot too soon after this surgery and try to go about your daily activity as normal, you risk complications and side effects as a result of an incomplete recovery.
A different post-surgical process is needed for endoscopic surgery when weight bearing can begin in a limited form immediately, and normal shoes can be worn as soon as is comfortable from individual to individual. People who undergo endoscopic surgery often find they’re able to return to their normal level of everyday activity within 3-6 months.
Your doctor will prescribe a strengthening and flexibility-building program for you to follow after the surgery. As with any other muscle or ligament in your body, the plantar fascia needs time to regain its strength and recover back to full capacity. However, no matter how strong you’re feeling, running and jumping is forbidden for a minimum of 3 months post surgery in order to assure you’ve had time to fully recover.
However, it’s not common for those with plantar fasciitis to undergo these procedures. This surgery is often only appropriate for approximately 5% of people diagnosed with plantar fasciitis. Reasons which could lead to the recommendation of surgery include…
The continued presence of severe and debilitating symptoms, even after successfully following a nonsurgical treatment plan of attack
Symptoms have continued for at least 6-12 months
Symptoms are affecting your performance as an athlete if this is your profession, or your ability to take part in a general athletic program
Your work is in some way affected even after nonsurgical treatment options have been followed and tested for a number of months
The good news is most people who undergo plantar fasciitis surgery report far less pain after this release has been carried out. Roughly 3/4 of people who have this surgery performed find themselves with a reduced pain level as a result.
There are a number of risks associated with plantar fasciitis surgery, which should be weighed and considered by any individual before making the decision to follow this course of treatment. These risks include…
The potential for damage to nerves, such as nerve entrapment or tarsal tunnel syndrome
Heel pain that is constant and reoccurring in everyday life post-surgery
Neuroma, which is a benign tumor made up of a mixture of nerve cells and nerve fibers
Infection, as with any surgery which requires incisions, opening your body up to a host of germs and weakening its overall defensive mechanisms
A delay in wound healing which impacts daily life, as some people don’t find their bodies heal as quickly and as well as others
The associated risks of anesthesia, which carry small but real dangers with them as every individual can react differently to various medications
If you decide to undergo surgery and want to opt for an endoscopic option, it’s important to ensure your surgeon has been specifically trained in the proper technique and has a history of successfully completing this particular surgery. You’re well within your rights to ask your surgeon how many endoscopic surgeries they have performed, and the outcomes of each.
Taping your plantar fasciitis
A very useful way to relieve some of the pain associated with your plantar fasciitis is to use taping techniques which will take away some of the strain experienced by the plantar fascia. By taping your foot, you’re also giving the tissues time to heal, which is extremely important when it comes to reaching a full recovery and getting back on your feet. The tape will need to be applied regularly until symptoms ease, but many patients report an immediately noticeable difference in their foot’s pain levels.
There are a number of methods you can test to see which is most effective in reducing your painful symptoms as a result of your plantar fasciitis condition.
The first method is recommended for a tear or strain which is located on the underside of your foot. The plantar fascia ligament goes from the top of the foot to the bottom of the heel, and it’s this area that needs to be targeted with taping principles to offload the area and provide a stronger support.
Of course, feet get easily sweaty, so you may find you need a spray adhesive that the tape can then be attached to.
When taping the foot of someone with plantar fasciitis, make sure the patient has relaxed their foot before you begin. If the foot is too tense, the patient will be in discomfort the moment they stand up, as the plantar fascia will be over tightened.
Begin by placing an anchor at the top of the foot, at the end of the plantar fascia. Just lay this strip on the skin with no tension. Next, follow the same step and lay a strip down the bottom of the foot, across the heel. Make sure you don’t lay the tape where the Achilles is as it can cause rubbing.
Once your top and bottom anchors are in place, it’s time to ensure the foot is completely relaxed while you apply the strips along the length of the plantar fascia. The best way to do this is to measure the tape against the foot’s size, taking into account a number of times you plan to wrap it, before cutting or ripping the tape.
It’s important to apply tape from the middle of the foot at the heel before running it outwards to the outside of the foot. Take another strip and apply it on the other side, and then a third in the foot’s center. Use your anchor strips to guide where the tape strips should run from – they should go from one anchor strip to another.
To give the tape more support, you can also apply another strip along the inside of the foot. To finish, re-do the anchors both at the top of the foot and the bottom of the foot. Apply a final strip across the medial arch of the foot to ensure as much support as possible is provided. This strip runs along the length of the medial arch before going around the heel and back towards the starting point.
The second method is a simple method. You may want to try both methods to see which provides a more effective support solution for your individual case. To tape the plantar fascia in this second way, begin on the outside of the foot, below the smallest toe. Apply a strip of non-stretch zinc oxide tape across the outer side of the foot, threading it under the heel before bringing it back across the sole. The goal is to bring the tape back to the same place you began from. It’s important that the tape is applied smoothly with no wrinkles, as blisters can result from wrinkles that can lead to further pain for the patient.
Now, do the same again, beginning on the inside of the foot right under the big toe and finishing up with the tape in the same position. The result will be a crossed pattern of tape on the foot. Repeat these steps until two pieces of tape have been placed on each side. To finish off, use short strips of tape underneath the foot to cover what you’ve done, being careful not to apply it too tightly. You can also use a small piece of tape across the top of the foot to connect the two sides in order to create an even more secure taping job.
Massage for Plantar fasciitis
Another treatment for plantar fasciitis is deep tissue sports massage. This is best left to professionals, who will know how to massage the foot and the plantar fascia in a way that provides pain relief without accidentally making any symptoms more intense.
A deep tissue sports masseuse will have a range of techniques that can help you with your plantar fasciitis pain. These include…
Light stroking across the top of the foot – by applying a light stroking movement to the topside of the foot, a masseuse can bring some relief to the patient. Light pressure is applied all the way from the ankle to the toes. This can provide relief to the patient depending on the damage done to their plantar fascia, and is a good place to start in any massage to ascertain the patient’s tolerance and level of comfort with further massage techniques.
Spreading the metatarsals – the metatarsal area is spread by pressure applied by the masseuse’s thumbs. This is another way relief can be provided to the plantar fascia as it encourages a release of tension.
Petrissage sole of the foot – by using thumbs to apply cross frictions from the heel, the masseuse will gradually make their way up the ball of the foot. This will be followed up by the application of firm pressure on the plantar fascia, down towards the heel. Whilst it might feel counter-intuitive to apply pressure to the ligament that is in pain, the application of this pressure is a tool used to encourage a reduction in tension.
Deep pressure from the heel of the hand – the heel of the hand is a useful tool in applying deep pressure that runs all the way from the ball of the foot down to the heel. Be warned – this is a technique which can involve some discomfort for the patient, but this discomfort is worth it, as it’s a very powerful technique for releasing pent up tension held in the plantar fascia. Talk to your masseuse before undergoing this technique to make sure you’re aware of the level of pressure they’ll apply, and to establish a clear line of communication in case you need to ask them to ease up. However, the momentary discomfort is worth it for the release of tension!
Circular frictions – Your masseuse therapist is able to apply circular frictions through their thumbs on any tight knots or tension points within the plantar fascia. Again, this is a technique that involves the application of pressure that could lead to some mild discomfort, but not so much pressure that any pain is caused to the individual. If you feel pain during the massage, speak up and ask your masseuse to either work lightly or try a different method.
Calf massage – because of the way the body’s ligaments and joints are connected so intrinsically, your plantar fascia may experience some release of tension as a result of an effective calf massage. Your therapist will be trained with calf massage techniques designed to help relieve this tension, so discuss with them the best options when it comes to using the body’s interconnectivity to provide some pain relief in the plantar fascia region.
Whilst nobody likes to hear anything but a healthy diagnosis after a trip to their GP, seeking help if you’re experiencing any symptoms of plantar fasciitis is the first step to recovery. Our feet are integral to our daily lives, and as such require respect and care to ensure they’re healthy, supported and getting the treatment they need for anything which isn’t in complete working order.
If you find yourself diagnosed with plantar fasciitis, invest the time and energy into establishing an effective treatment plan with your doctor and with a support network of experts who can bring their skills to the table in order to provide you with not only pain relief, but also the opportunity to heal. Familiarize yourself with the various methods of treatments and create a plan that allows you the time you need to recover from your plantar fascia’s injuries whilst maintaining as much of your everyday life as possible.
With adequate care, attention and time, healing is possible for plantar fasciitis, and your plantar fascia can be working as good as new. Imagine how great going for a run will feel on the other side of this!