What Exactly Can Cause Plantar Fasciitis

Overview

Plantar fasciitis: Inflammation of the plantar fascia, the bowstring-like tissue that stretches from the heel bone to the base of the toes. Plantar fasciitis can be due to calcaneal spurs, which typically cause localized tenderness and pain that is made worse by stepping down on the heel. Plantar fasciitis may be related to physical activity overload, abnormal foot mechanics, or may be due to underlying diseases that cause arthritis, such as Reiter disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Treatment is designed to decrease inflammation and avoid reinjury. Icing reduces pain and inflammation. Anti-inflammatory agents, such as ibuprofen and injections of cortisone, can help. Infrequently, surgery is done on chronically inflamed spurs. A donut-shaped shoe insert can take pressure off a calcaneal spur and lessen plantar fasciitis.




Causes

When the foot moves, the plantar fascia stretches and contracts. Plantar fasciitis is caused by the repetitive overstretching of the plantar fascia. If the tension on the plantar fascia is too great, this overstretching causes small tears in the plantar fascia. This in turn causes the plantar fascia to become inflamed and painful. Factors that contribute to the development of plantar fasciitis include having very high arches or flat feet, gender, while anyone can develop plantar fasciitis, it tends to occur more commonly in women, exercises such as running, walking and dancing, particularly if the calf muscles are tight. Activities or occupations that involve walking or standing for long periods of time, particularly on hard surfaces, wearing high heeled shoes or shoes that do not offer adequate arch support and cushioning, being overweight, additional weight increases the tension on the plantar fascia, poor biomechanics, extra tension is placed on the plantar fascia if weight is not spread evenly when standing, walking or running. Some cases of plantar fasciitis may be linked to underlying diseases that cause arthritis, such as ankylosing spondylitis.




Symptoms

The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but can affect both feet. Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel. The pain is usually worse in the morning when you take your first steps out of bed, or if you’ve been sitting or lying down for a while. Climbing stairs can be very difficult due to the heel stiffness. After prolonged activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.




Diagnosis

Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.




Non Surgical Treatment

Treatments you can do at home include rest. Try to avoid activities that put stress on your feet. This can be hard, especially if your job involves being on your feet for hours at a time, but giving your feet as much rest as possible is the first step in reducing the pain of plantar fasciitis. Use ice or a cold compress to reduce pain and inflammation. Do this three or four times a day for about 20 minutes at a time until the pain goes away. Take anti-inflammatory medications. Painkillers such as ibuprofen or acetaminophen can help relieve pain and reduce inflammation in the affected area. Your doctor may also prescribe a medication called a corticosteroid to help treat severe pain. Exercise your feet and calves. When the pain is gone, do calf and foot stretches and leg exercises to make your legs as strong and flexible as possible. This can help you avoid getting plantar fasciitis again. Ask your coach, athletic trainer, or a physical therapist to show you some leg exercises. Rolling a tennis ball under your foot can massage the area and help the injury heal. Talk to your doctor about shoe inserts or night splints. Shoe inserts can give your feet added support to aid in the healing process. Night splints keep your calf muscles gently flexed, helping to keep your plantar fascia from tightening up overnight. Have a trainer or sports injury professional show you how to tape your foot. A proper taping job allows your plantar fascia to get more rest. You should tape your foot each time you exercise until the pain is completely gone. For people who get repeated sports injuries, it can help to see a sports medicine specialist. These experts are trained in evaluating things like an athlete's running style, jumping stance, or other key moves. They can teach you how to make the most of your body's strengths and compensate for any weaknesses. Once you're healed, look for the silver lining in your bench time. You may find that what you learn from having an injury leads you to play a better game than ever before.






Surgical Treatment

If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid factor, human leukocyte antigen B27 (HLA-B27), and uric acid. It’s important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.




Prevention

Make sure you wear appropriate supportive shoes. Don't over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight, obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol - RICED-rest, ice, compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis, Consult a medical professional (such as a Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.