Plantar Fasciitis Treatment- Orthopedics, Physical Medicine And Rehabilitation, Podiatric Medicine

Plantar fasciitis is one of the most frequently encountered causes of heel and foot pain. This condition happens when the plantar fascia, which is the band of fibrous tissue present in the soles of your feet, becomes inflamed.

The inflammation usually causes sharp pain in the heels that’s mostly felt after you wake up and take your first steps. This pain typically fades away and improves as you get moving throughout the day. Nevertheless, it is common that the pain returns if you spend a lot of time on your feet, or you get up quickly from a sitting or sleeping position.

Plantar fasciitis is most often seen in runners, however, several other factors can also put you at risk.

Symptoms

The cardinal symptom of plantar fasciitis is the characteristic stabbing pain in the heel and sole of your foot. The pain is typically most pronounced in the morning after you get up and take your first steps. Standing for extended periods of time, or getting up from a sitting position can also provoke the pain. Another characteristic of the plantar fasciitis is that the pain is often more intense after, and not during, exercise. 

Causes

The plantar fascia is a group of fibrous bands that extend from your heel to your toes, running along the whole length of the sole of your foot. These bands play an important role in supporting the joints in your foot and absorbing when walking. When you overwork your feet and apply pressure on them (by walking or exercising for example) for an extended period of time, tiny tears can occur in the fibrous bands, leading to inflammation.

Risk Factors

Many times, plantar fasciitis happens without an identifiable cause, however, research has identified some factors that put you at risk of developing the condition:

• Age:  People aged between 40 and 60 are at higher risk of developing plantar fasciitis
• Some workout routines: certain physical activities can exert a significant amount of pressure on the sole of your foot, injuring the plantar fascia. Such exercises include long-distance walking or jogging, especially if done wearing shoes that don’t provide proper support.
• Flat feet: this is a postural deformity in which the sole of the foot becomes completely flat instead of being arched, leading to an abnormal distribution of body weight with subsequent inflammation and pain.
• Being overweight or obese: more bodyweight means more pressure on your feet, and a higher risk of developing plantar fasciitis.
• Certain jobs: people whose jobs require them to spend a lot of time standing or walking on rigid surfaces are more likely to injure the plantar fascia

Diagnosis

Most of the time, a general practitioner or orthopedist can diagnose plantar fasciitis based on medical interrogation and physical exam alone, without needing to perform any further testing. Sometimes, if your doctor is suspecting something other than plantar fasciitis, an X-ray or an MRI of the foot might be ordered. Conditions like a stress fracture in the foot can have symptoms that mimic those of plantar fasciitis, and imaging tests can help make the diagnosis in people at risk.

Treatment

In most cases, the pain resolves in a couple of months without any advanced interventions. Applying ice packs, resting, and stretching are usually enough to make the problem go away. When the pain persists or is unbearable, other forms of therapy may be indicated:

• Medications: pain killers and anti-inflammatory drugs may be prescribed to relieve the pain and decrease the inflammation associated with plantar fasciitis.
• Physical therapy: this can help improve your posture and enhance muscular support in your legs and feet to gain a better distribution of weight, and relieve some of the stress on your plantar fascia.
• Support devices: Dorsal night splints, sleep support braces, and other devices can be recommended to you by your doctor. The dorsal splint is worn at night to keep the foot in a “dorsiflexion” position, reducing pressure on your plantar fascia and stretching it out. Orthotics are also prescription support devices that you can wear inside your shoes to support the foot’s arch.

If supportive and medical therapy fails to relieve the symptoms, an orthopedist might suggest one of the following procedures:

• Steroid injections: Steroids have excellent anti-inflammatory properties and have been used for a long time in treating tendon and joint inflammation. Your doctor might use an ultrasound device to guide the injections in your foot.
• Extracorporeal shock wave therapy: In this procedure, your doctor uses a special device that emits sound waves to stimulate healing in the plantar fascia.
• Surgery: Surgery is considered the last resort when all medical and conservative therapy fails. Your doctor will usually wait 6 to 12 months before opting for surgery. The procedure is called “plantar fascia release”, and during the surgery, the orthopedic surgeon will loosen the plantar fascia where it attaches to your heel bone. The procedure is usually done under local anesthesia.

Home remedies

Here are a few things that you can do to reduce or prevent plantar fasciitis:

• Apply ice packs can reduce inflammation and pain
• Lose some weight if you need to
• Choose athletic shoes with good sole support
• Avoid sports stressing on your feet for a while
• Perform plantar and calf stretching exercises

If you suspect that you might have plantar fasciitis, you should rest and avoid strenuous exercise and allow your plantar fascia to heal. If the pain persists or is too intense, it would be wise to visit a general practitioner or an orthopedist to get a full assessment and prescribe proper treatment.

Sources:

• https://www.uptodate.com/contents/plantar-fasciitis
• https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs
• https://orthoinfo.aaos.org/globalassets/pdfs/planter-fasciitis.pdf
• https://pubmed.ncbi.nlm.nih.gov/29284574/

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