Plantar Fasciitis – Causes, Symptoms and Treatment
Plantar fasciitis is a painful inflammation of the plantar fascia in the foot, typically causing heel pain. It is one of the most common causes of foot pain in adults.
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Plantar fasciitis is a painful inflammation of the plantar fascia in the foot, typically causing heel pain. It is one of the most common causes of foot pain in adults.
What is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the plantar fascia, a thick band of connective tissue that runs along the bottom of the foot, connecting the heel bone (calcaneus) to the toes. It supports the arch of the foot and plays a key role in walking and running. Plantar fasciitis is one of the most common causes of heel pain in adults and can affect both active and sedentary individuals.
Causes
Plantar fasciitis develops due to repeated overstrain or microtears in the plantar fascia tissue. Common causes and risk factors include:
- Excess body weight: Increases pressure on the plantar fascia
- Prolonged standing or walking: Occupations such as retail workers, teachers, and healthcare professionals are at higher risk
- Sports overuse: Running, jumping, and high-impact activities
- Foot deformities: Flat feet (pes planus) or high arches (pes cavus)
- Tight calf muscles: Reduced ankle flexibility and shortened Achilles tendon
- Inappropriate footwear: Poor cushioning or lack of arch support
- Age: Most common between the ages of 40 and 60
Symptoms
The hallmark symptom of plantar fasciitis is a sharp or burning heel pain, most intense with the first steps in the morning or after periods of rest. Common symptoms include:
- Pain at the base of the heel, especially on the inner side
- Morning start-up pain that eases after a few steps
- Worsening pain after prolonged standing, walking, or exercise
- Occasional pain radiating along the arch of the foot
- Tenderness when pressing directly on the heel
Diagnosis
Diagnosis is primarily clinical, based on the patient history and physical examination. Additional diagnostic tools may include:
- Clinical examination: Point tenderness at the medial calcaneal tubercle (the attachment site of the plantar fascia)
- Ultrasound: Thickening of the plantar fascia (greater than 4 mm is considered abnormal)
- X-ray: To rule out a heel spur (calcaneal spur) or bony abnormalities
- MRI (Magnetic Resonance Imaging): Used in atypical presentations or when conservative treatment fails
Treatment
The majority of plantar fasciitis cases resolve with conservative treatment. Most patients recover within 6 to 18 months.
Conservative Treatment
- Stretching and physiotherapy: Targeted stretching of the plantar fascia and calf muscles is the most effective first-line intervention
- Orthotic devices: Heel pads and arch-supporting insoles to reduce strain on the fascia
- Night splints: Keep the foot in mild dorsiflexion overnight to reduce morning start-up pain
- Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac for short-term relief
- Physical therapy modalities: Ice therapy, ultrasound therapy, shockwave therapy
- Corticosteroid injections: Local injections for persistent cases (short-term benefit)
Extracorporeal Shockwave Therapy (ESWT)
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that delivers acoustic waves to the affected tissue, promoting blood flow and tissue regeneration. It is considered an effective option for chronic plantar fasciitis that has not responded to standard conservative treatment.
Surgical Treatment
Surgery is rarely necessary and is considered only in approximately 5% of patients who do not respond to 12 months of conservative treatment. The most common procedure is a partial plantar fasciotomy (partial release of the fascia).
Prevention
- Wear well-cushioned, supportive footwear
- Regularly stretch the foot and calf muscles
- Gradually increase physical activity levels
- Maintain a healthy body weight
References
- Buchbinder R. - Plantar Fasciitis. New England Journal of Medicine, 2004; 350:2159-2166.
- Goff JD, Crawford R. - Diagnosis and Treatment of Plantar Fasciitis. American Family Physician, 2011; 84(6):676-682.
- Landorf KB. - Plantar heel pain and plantar fasciitis. BMJ Clinical Evidence, 2015; 2015:1111.
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