Plantar Fasciitis – A common cause of pain in inferior heel

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Tuesday, 03 November 2015 618 Views 0 Comments
Plantar Fasciitis – A common cause of pain in inferior heel

By Shailja Kaushik

A 50-year-old overweight woman has been facing pain in her right inferior heel for the last three months. Every morning when she wakes up, she finds it difficult to take her first steps. This is a classic symptom of a condition known as plantar fasciitis.

Did you know?

  • Plantar fasciitis, reportedly the most common cause of pain in the inferior heel, is estimated to account for 11 to 15% of all foot symptoms requiring professional care among adults.[i], [ii]
  • Plantar fasciitis has been reported to account for about 10% of injuries that occur in connection with running.[iii]

What is plantar fasciitis?

There is a tough and fibrous band of connective tissues, known as the plantar fascia, which joins the heel bone to the base of the toes, and creates the foot arch. Due to overuse or excessive pressure on the sole of the foot, these tissues get inflamed, resulting in heel pain and swelling.

Causes

In his book Health Basics: A Doctor’s plainspoken advice about how your body works and what to do when it doesn’t, Michael S. Richardson mentions that when a person is involved in activities that outpace the body’s ability to repair itself, then the collagen fibers that make up the plantar fascia are subject to repeated microscopic tears, resulting in their degeneration and leading to the condition known as ‘Plantar Fasciitis’.[iv]

According to a research study Clinical Practice of Plantar Fasciitis by Rachelle Buchbinder, published in The New England Journal of Medicine, the cause of plantar fasciitis is not clearly understood but certain risk factors have been identified. These are:

  • Obesity
  • Occupations requiring prolonged standing
  • Pes planus (excessive pronation of the foot)
  • Reduced ankle dorsiflexion
  • Inferior calcaneal exostoses (or heel spurs)

The same study also indicates that plantar fasciitis in runners or athletes may be caused by repetitive micro-trauma to the tissues. Among runners, athletes and sportsperson, risk factors include:

  • Excessive running
  • Wearing improper running shoes with soft soles or poor arch support
  • Running on unyielding surfaces
  • Sudden increase in the distance run
  • Having a shortened Achilles tendon, or a high-arched foot

Though both men and women are at equal risk of developing plantar fasciitis; active males over the age of 40 are more likely to complain of the condition.

plantar_fasciitis_common_running_injury.eps

Symptoms

Difficulty in taking the first steps in the morning is the most typical symptom of plantar fasciitis. The other symptoms one should look for are:

  • Pain, soreness and stiffness in the heels
  • Burning or aching sensation at the bottom of the foot
  • Worsening of the pain especially after exercise or intense activity, climbing stairs, standing or sitting for long.

Prevention

Plantar fasciitis can be prevented by keeping the Achilles tendon, ankle and calf muscles flexible. Stretching exercises as well as limiting the distance, frequency and duration of running are other prevention strategies. Exercise in moderation is the best advice to prevent plantar fasciitis.

Treatment

Non-surgical treatment methods include the following:

  • Stop activities that worsen the pain
  • Take adequate rest
  • Roll an ice pack over the affected foot for 20 minutes. Repeat this for 3-4 times a day
  • Stretching the calf muscles and the plantar fascia i.e. bottom of the foot also help to relieve pain
  • Wear shoes with thick soles and extra cushioning
  • Avoid running or doing activities on hard surfaces
  • Use shoe inserts or orthotics.
  • To reduce pain and inflammation, doctors may prescribe non-steroidal anti-inflammatory medication (such as Acetaminophen or Ibuprofen) or cortisone (a kind of steroid) injections.

The patient may be asked to work with a physiotherapist to follow a specialised program that includes stretching exercises, massages and medications to reduce inflammation of the foot tissues.

Extracorporeal Shockwave Therapy (ESWT) is another procedure which involves the use of high-energy shockwave impulses to trigger the healing of damaged plantar fascia tissue.  However, research has shown that this has generally failed to produce satisfactory results. Being a non-invasive method, it may be given a try before foot surgery.

The book Sports & Exercise Injuries: Conventional, Homeopathic & Alternative Treatments outlines the most important measures for treating plantar fasciitis are to rest the foot, tape it or insert orthotics into shoes. Taping is found to be very important because the big toe must be kept from moving too much. The same book advices, that in the early stages, plantar fasciitis may be cured with ultrasound therapy or electro-galvanic stimulation, and a foot orthotic. If the problem continues to worsen, it may require surgery.[v]

The progress is tracked for 12 months. Only when the condition is not treated with non-surgical methods, then the doctors recommend surgery. Surgery may involve either lengthening of the calf muscles which makes it flexible or partial cutting of the affected tissue to release the tension. Most of the patients respond well to the surgery.

References
[i]  McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions: a cryomicrotomy study. J Am Podiatry Assoc 1979; 69:527-36.
[ii] Pfeffer G, Bacchetti P, Deland J, et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar r fasciitis. Foot Ankle Int 1999;20: 214-21
[iii] Ballas MT, Tytko J, Cookson D. Common overuse running injuries: diagnosis and management. Am Fam Physician 1997; 55:2473-84.
[iv]  Michael S. Richardson. Health Basics: A Doctor’s Plainspoken Advice about how Your Body Works and what to do when it Doesn’t. Next Decade, Inc., 2003.
[v] Steven I. Subotnick. Sports & Exercise Injuries: Conventional, Homeopathic & Alternative Treatments. North Atlantic Books, 1991.

(Dr. Rohan Habbu is an Orthopedic Hand, Nerve & upper Extremity Surgeon. He has done Fellowship in Arthroscopy & Sports Surgery and is an avid runner. To know more, reach out to him on rohanhabbu@gmail.com or +91 982017 13941)

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