What is plantar fasciitis and how is it caused?
Plantar fasciitis, or heel pain as it is more commonly called, is the inflammation or degeneration of a structure within the foot called the plantar fascia (Schwartz, 2014).
The plantar fascia is a thick fibrous band that extends from your heel through to the base of your toes and functions to support the arch of your foot. It is thought that repetitive strain and overload from long periods of standing, activity, and a person’s foot type is the cause of this painful inflammation and/or degeneration (Schwartz, 2014).
Who does plantar fasciitis effect?
Plantar fasciitis is one of the most common causes of foot pain and is estimated to effect 1 in 10 people during their lifetime (Riddle, Pulisic, Pidcoe, & Johnson, 2003). Plantar fasciitis can affect people in both sedentary and athletic populations, and anyone in between (Schwartz, 2014). However, research indicates that the peak incidence of the condition is amongst those aged between 45 and 64 years, and that it is more common amongst women. Those with either excessively flat, or high arched feet are also at an increased risk of developing plantar fasciitis (Riddle & Schappert, 2004).
What are the symptoms of plantar fasciitis?
Patients will usually present with a gradual onset of pain at the medial, or inner side of the heel (Lim, How & Tam 2016). This pain is often described as ‘first step pain’ and presents as severe pain occurring with the first few steps after rest, and then improving with movement. However, the pain may be re-aggravated by long periods of weight bearing (Schwartz, 2014). Clinically, palpation of the plantar medial heel will often result in tenderness, as will dorsiflexion of the first toe (Schwartz, 2014).
How do we treat plantar fasciitis?
For the vast majority of patient’s plantar fasciitis can be treated conservatively and without the need for surgical intervention (Lim, How & Tam 2016). Conservative management of plantar fasciitis often requires several treatment modalities in order to have the best chance of recovery. Some common and evidence-based treatment methods include:
- Avoidance of any repetitive and high impact activities with gradual progression and building back to pre injury levels(Lim, How & Tam 2016),
- Simple plantar fascia and calf stretches, in combination with ice massage (Lim, How & Tam 2016),
- Strength and isometric loading programs (Lim, How & Tam 2016),
- Low-dye taping to provide the medial arch of the foot with some initial support (Schwartz, 2014),
- More appropriate and supportive footwear choices,
- Orthotic therapy as a longer-term treatment method (Cutts, Obi, Pasapula & Chan 2012).
Unfortunately, not all cases of plantar fasciitis respond to conservative management. In sapproximately 5% of patients surgical intervention may be required (Lim, How & Tam 2016).
References
Cutts S, Obi N, Pasapula C & Chan W 2012, ‘Plantar Fasciitis’, Annals of the Royal College of Surgeons of England, vol. 94, no. 8, pp. 539-542.
Lim AT, How CH & Tam B 2016, ‘Management of plantar fasciitis in the outpatient setting’, Singapore Medical Journal, vol. 57, no. 4, pp. 168-171.
Riddle DL, Pulisic M, Pidcoe P & Johnson RE 2003, ‘Risk factors for plantar fasciitis: a matched case-control study’, Journal of Bone and Joint Surgery, vol. 85, pp. 872–7.
Riddle DL & Schappert SM 2004, ‘Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors’, Foot Ankle Int., vol. 25, no. 5, pp. 303-310.
Schwartz EN, 2014, ‘Plantar Fasciitis: A Concise Review’, The Permanente Journal, vol. 18, no. 1, pp. 105-107.