Plantar fasciitis causes pain under the heel. The discomfort may radiate to the toes or lower leg. We explain what you should know about this very common pathology.
Doctors understand the term “plantar fasciitis” as irritation and inflammation of the thick band that runs along the sole of the foot (plantar fascia) from the heel bone (calcaneus) to the toes. It is usually caused by overloading.
It is usually very stressful for those affected because it severely affects daily activities and especially if running or playing a sport. Women are affected more often than men, most likely by the use of shoes with heels.
The plantar fascia acts on the take-off of the foot during walking and ensures the transmission of force from the forefoot to the rearfoot. The function of the fascia is to stretch the longitudinal arch, align the back and front of the foot, absorb impacts, and lift the arch of the foot.
WHAT ARE THE SYMPTOMS OF PLANTAR FASCIITIS?
The onset of plantar fasciitis is insidious: the discomfort gradually worsens over weeks or months.
You feel burning or pain mainly in the heel. At first the discomfort appears in conditions of effort, when running, for example, and then when getting up in the morning and taking the first steps. This is a very common and revealing symptom of the alteration. After a short period of walking, it may disappear.
Those affected usually report a sharp pain and tightness under the foot or in the heel area. Sometimes it is impossible to walk.
During sports practice, those affected feel pain at the beginning of the effort, which decreases as the warm-up increases. Towards the end of training, symptoms return. Running and jumping, in particular, increase pain.
WHAT CAUSES PLANTAR FASCIITIS?
- The most common cause of plantar fasciitis is overloading from running or jumping, which causes small tears in the fascia. High-risk sports include basketball, tennis, and soccer and dance. It is most likely from the age of 40.
- The problem may be favored by shortening of the Achilles tendon or by bursitis (inflammation of the synovial bursa) in the insertion of the plantar fascia.
- Being overweight and standing for many hours are risk factors for plantar fasciitis.
- The use of shoes with high heels and flip-flops favors the appearance of the problem.
- Having flat feet or cavus (with too much bridge) also predisposes to plantar fasciitis.
WHAT IS THE TREATMENT OF PLANTAR FASCIITIS?
Plantar fasciitis is one of the most persistent and frustrating sports injuries. There are many treatment options. Conservatives based on exercises, stretching, ice, etc., can cure the condition in a few months. In some cases, however, surgical intervention is necessary. If not treated properly and in time, plantar fasciitis can become a chronic condition.
1. CONSERVATIVE TREATMENT
To reduce the inflammation and pain associated with plantar fasciitis, the initial treatment consists of modifying sports practice. The doctor analyzes the training methods and circumstances, for example, if running on asphalt or stones, if there is an overload of effort, and changes in habits and specific exercises are suggested.
- Stretching exercises for the calf and plantar muscles. They are an essential part of conservative treatment. 72% of patients improve their symptoms with stretching alone. One of them is to roll your foot on a bottle full of ice. Another stretch is performed by wrapping the forefoot with a towel to force passive flexion of the foot, pulling the towel upwards. Doctors and physiotherapists recommend repeating stretching exercises about three times a day for at least ten minutes.
- Use insoles in the footwear that support and straighten the longitudinal arch.
- Night splints can keep the Achilles tendon stretched to reduce pain in the mornings.
- Bandages: can stabilize the foot and arch of the foot. They cushion pressure on the tendon when walking, thus reducing stress and pain in the heel. A physical therapist can teach the patient how to make the bandage.
- Physiotherapy: Special massages over the tendon insertion relieve pain. Training the foot muscles is also part of the therapy.
- Weight reduction: Overweight people are more prone to plantar fasciitis because the tendon is under increased strain. If there is inflammation and also severe obesity, weight reduction is usually part of therapy.
- Ultrasonic wave therapy: it is an increasingly used technique due to its success, but the cost is high so it is only performed in cases that do not respond to conservative treatment.
- Inflammatory X-ray radiation: useful in two out of three cases but involves exposure to potentially carcinogenic radiation.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce discomfort. Cortisone injections can also be used, but if they are repeated, they increase the risk of tendon rupture.
WHAT CAUSES PLANTAR FASCIITIS?
- The most common cause of plantar fasciitis is overloading from running or jumping, which causes small tears in the fascia. High-risk sports include basketball, tennis, and soccer and dance. It is most likely from the age of 40.
- The problem may be favored by shortening of the Achilles tendon or by bursitis (inflammation of the synovial bursa) in the insertion of the plantar fascia.
- Being overweight and standing for many hours are risk factors for plantar fasciitis.
- The use of shoes with high heels and flip-flops favors the appearance of the problem.
- Having flat feet or cavus (with too much bridge) also predisposes to plantar fasciitis.
WHAT IS THE TREATMENT OF PLANTAR FASCIITIS?
Plantar fasciitis is one of the most persistent and frustrating sports injuries. There are many treatment options. Conservatives based on exercises, stretching, ice, etc., can cure the condition in a few months. In some cases, however, surgical intervention is necessary. If not treated properly and in time, plantar fasciitis can become a chronic condition.
1. CONSERVATIVE TREATMENT
To reduce the inflammation and pain associated with plantar fasciitis, the initial treatment consists of modifying sports practice. The doctor analyzes the training methods and circumstances, for example, if running on asphalt or stones, if there is an overload of effort, and changes in habits and specific exercises are suggested.
- Stretching exercises for the calf and plantar muscles. They are an essential part of conservative treatment. 72% of patients improve their symptoms with stretching alone. One of them is to roll your foot on a bottle full of ice. Another stretch is performed by wrapping the forefoot with a towel to force passive flexion of the foot, pulling the towel upwards. Doctors and physiotherapists recommend repeating stretching exercises about three times a day for at least ten minutes.
- Use insoles in the footwear that support and straighten the longitudinal arch.
- Night splints can keep the Achilles tendon stretched to reduce pain in the mornings.
- Bandages: can stabilize the foot and arch of the foot. They cushion pressure on the tendon when walking, thus reducing stress and pain in the heel. A physical therapist can teach the patient how to make the bandage.
- Physiotherapy: Special massages over the tendon insertion relieve pain. Training the foot muscles is also part of the therapy.
- Weight reduction: Overweight people are more prone to plantar fasciitis because the tendon is under increased strain. If there is inflammation and also severe obesity, weight reduction is usually part of therapy.
- Ultrasonic wave therapy: it is an increasingly used technique due to its success, but the cost is high so it is only performed in cases that do not respond to conservative treatment.
- Inflammatory X-ray radiation: useful in two out of three cases but involves exposure to potentially carcinogenic radiation.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce discomfort. Cortisone injections can also be used, but if they are repeated, they increase the risk of tendon rupture.
3. OTHER TREATMENT OPTIONS
- Herbal pain ointments are available in pharmacies and contain active ingredients such as arnica, an alpine flowering plant with analgesic and anti-inflammatory effect. It should be noted that these ointments contain active ingredients in low concentrations and their effect has not been clearly scientifically proven.
- It can be treated with castor oil and capsaicin. Castor oil stimulates the formation of collagen in particular and strengthens the structure of tendons. In addition, it has an anti-inflammatory effect. Capsaicin is used as an analgesic in the form of patches and ointments, especially in sports.
- The cold acts against pain and inflammation on the sole of the foot. You can apply cold packs found in pharmacies and sports stores. It is most useful when applied in the initial phase of the problem.
- Heat is an equally useful remedy for heel pain. Like cold, it stimulates blood circulation and self-healing processes. It provides relaxation and loosens hardened tissue. Therefore, massages with hot and skin-friendly oils are very suitable as a supportive measure in the treatment of plantar fasciitis and can be performed at home.
Home and natural remedies have their limits. If symptoms persist, do not improve, or even worsen, a doctor should always be consulted.
WHAT ARE THE CHANCES OF PLANTAR FASCIITIS HEALING?
For most patients with plantar fasciitis, conservative treatment methods are successful and a cure is possible in 80 to 90% of cases. However, in some cases the healing process can take up to one to two years.
In 10% of cases the problem is chronicled by the degeneration and thickening of the fascia. In some cases, in the opinion of the doctor, surgery can be performed that significantly reduces symptoms (80%) in 90% of patients.
CAN PLANTAR FASCIITIS BE PREVENTED?
Since plantar fasciitis is usually due to overloading of untrained muscles and corresponding tendons, doctors advise athletes to perform proper warm-ups before intense exercise.
Stretched muscles and tendons are less likely to become inflamed or torn. Stretching exercises that are performed after physical training help preventively. This also applies to activities where people run or jump a lot, either professionally or in their spare time.
Footwear is also important. Not wearing shoes with heels more than 3 cm high and wearing shoes with good support and cushioning for sports helps prevent inflammation of the plantar tendon.
