Have you ever felt pain in the bottom of your heels, after running or any strenuous activity? If yes, then this pain can be an indicator of plantar fasciitis, a medical condition also known as heel spur syndrome in case a spur exists.
Plantar fasciitis refers to the inflammatory condition in the tissue band (the plantar fascia) stretching from the heel to toes. Initially, the fascia gets irritated followed by inflammation, which triggers heel pain. It is often linked with impact activities, such as those involving running on toes instead of on heels.
While there can be several reasons of such heel pain like nerve irritation, arthritis, or stress fracture, plantar fasciitis is perhaps the most common trigger of heel pain in athletes, often spreading until the foot’s arch. Almost 1 out of every 10 people have it at some point of time. It is widespread amongst the age group of 40 to 60 years, although there is no specific age of its occurrence. As compared to men, it is more common in women.
Understanding Plantar Fascia
Plantar fascia refers to a broad and thick ligament or tissue band linking the front of the foot to the heel. Its main functions are to support the foot’s arch by absorbing shocks and assist in walking. This ligament undergoes much wear and tear almost on daily basis. Therefore, too much pressure or stress on feet can worsen the normal working condition of this tissue. With overuse, the fascia can become painful and inflamed at a spot where it connects to the heel bone.
What Causes It?
Removing some misconceptions before revealing the actual causes…
This common orthopedic complaint was thought to be due to inflammation only, but is now alleged as imprecise due to the lack of inflammatory cells in the ligament. This means inflammation is not necessarily the only cause.
Similarly, another misconception was that plantar fasciitis is due to a heel spur. However, the latest research has held it false because x-rays have revealed heel spurs even in people not suffering from plantar fasciitis. A heel spur is a bone hook forming on the heel. According to OrthoInfo, while 1 out of every 10 people suffers from such a spur, only 1 out of 20 patients feel the pain.
So, what is the actual cause?
Well, just like shin splints, there is single or universal cause of plantar fasciitis. Medically, the most common trigger of pain in fasciitis is the degeneration of collagen fibres present near joint to the heel. Other causes of fasciitis pain are as follows:
- Poor Foot Biomechanics: Such a type of foot composition usually put more burden on the plantar fascia.
- Overweight or Obesity: This factor can increase stress or pressure on the fascia ligament, particularly if the weight gain is all of a sudden. This is perhaps why even pregnant women tend to experience spells of plantar fasciitis, especially in third trimester.
- Long Distance and Speedy Running: Whether you are a beginner or experienced runner, running for several miles at high speed and at once can put strain on the fasciitis ligaments.
- Running on Hard Surfaces: If you have chosen asphalt, sloping, uneven, or concrete surfaces for playing or running, it can put a lot of strain on fasciitis ligament.
- Overpronation: If you run with feet rolling inward or flattening excessively, you are at high risk. This is because the ligament stretches excessively with over flattening or rolling inward behavior of the feet. Overuse injury or frequent over-stretching of the ligament under the foot can inflame or thicken the fascia. The more the thickening, the less is its strength and flexibility. This cause is more common in sport players and dancers.
- Tight Calf Muscles: This is responsible for a high velocity or prolonged pronation. This gives rise to other causes such as low arched or high arched foot.
- High Arched Foot: Such behavior makes the feet incapable of absorbing shock, which means they cannot adjust or adapt to the surface. This puts more strain on the fasciitis ligaments.
- Improper Footwear: Such pair of shoes does not offer sufficient arch support. Wearing a pair having soft soles usually can trigger the problem. Therefore, it is ideal to choose a pair that ensures proper arch support, is lace-up, and is flat. Similarly, wearing high heels for hours prior to wearing flat running shoes can also result fasciitis pain.
- Tight Achilles Tendons: These tendons linking the heels to calf muscles can also trigger fascia pain.
- Previous Injury: If you have a history of plantar fascia strain or an underneath foot injury not healed completely, it can contribute to plantar fasciitis pain.
Symptoms of Plantar Fasciitis
Pain and stiffness in the heel’s bottom and/or in the foot’s arch are perhaps the most prevalent symptoms of plantar fasciitis. These symptoms tend to develop slowly and usually affect one of the feet, although they can strike in both the foot. While a few complain about the dull pain, others describe the pain as an acute one characterized by an ache or burn feeling at the foot’s bottom. This pain is experienced often as a worse one:
- When you make the initial steps after waking up in the morning
- While climbing stairs
- After sitting or standing for some time, not during the activity
- After intense workout or activity that can result in inflammation and subsequently, flare-ups
Some more symptoms and signs:
- High arches or flat feet
- Tenderness on the foot’s bottom
- Mild swelling or redness in foot
Types of Plantar Fasciitis
Medically, plantar fasciitis is found to be the outcome of one of the two ways namely, compression injury and traction injury.
In case of traction plantar fasciitis, the symptoms worsen through stretching or traction forces on the fascia. This means that the fascia is frequently overstretched due to an elongated arch, improper foot biomechanics, weak foot arch muscles, or over pronation. On the other hand, the compression type is associated with a traumatic cause, such as sudden stepping on a sharp object. In this case, the pain is likely to be far under your arch and not heel. However, this is not a stone bruise or a fat pad contusion.
While no single cure exists, several remedies exist for relieving fasciitis pain. These remedies are short-and long-term ones. For effectively treating the condition in the long-term, it is essential to target the actual cause apart from healing the symptoms. To begin with, you can consider the following treatments at home:
- Apply an ice pack for 20 minutes on the heel, several times a day to heal inflammation, without direct contact with the skin (use a towel in between ice and heel).
- Stretch your calf muscles with some stretching exercises to relieve pain and ensure quick recovery.
- Avoid strenuous activities or walking barefoot to make your heel rest.
- Wear stability or supportive shoes with sufficient arch support with a bit raised heel to alleviate fascia stress.
In case pain persists after weeks of trying one or more of these remedies, it becomes essential to visit your orthopedic surgeon who then can suggest one or more treatments as described below.
- Placing shoe pads to soften the walking impact
- Strapping for reducing fascia strain and supporting the foot
- Using orthotic devices in the footwear to rectify the prevalent structural abnormalities resulting in plantar fasciitis
- Wearing a night splint to retain the desired stretch of fascia at the time of sleeping, so that morning pain reduces
- Using a removable walking cast for having an immobile foot so that it heals and rests
- Having corticosteroid injections for relieving inflammation and pain
- Undergoing physical therapy including exercises for relief