By Rehan Iqbal
In April this year, the legendary golfer, Tiger Woods, took to his Twitter page to announce he was withdrawing from the Masters Tournament due to a foot injury called plantar fasciitis (PF).
“I am disappointed to have to WD this morning due to reaggravating my plantar fasciitis,” Mr. Woods, 47, tweeted.
And recently, the popular NBA player Lebron James was suspected of suffering a partial plantar fascia tear.
Are Only Athletes Affected by Plantar Fasciitis?
Why athletes, yeah? Actually, plantar fasciitis is common among athletes, but ordinary regular people also get it.
Plantar fasciitis causes pain in the bottom of the foot near the heel. I combed a few social media platforms where patients and experts shared their experiences and tips.
Most patients say the pain is debilitating; it affects mobility and the ability to perform daily activities. Experts say the injury is self-limited, meaning it may resolve on its own. However, they often prescribe rest, ice, exercise, and non-steroidal anti-inflammatory drugs (NSAIDs).
Severe cases lasting more than 6 months may require surgery.
This article discusses plantar fasciitis, its causes, risk factors, diagnosis, and treatment.
What is Plantar Fasciitis?
Plantar Fascitis is one of the commonest foot issues affecting about 2 million people yearly, according to the American Academy of Orthopaedic Surgeons.
To fully understand plantar fasciitis, it’s necessary to describe the anatomy and functions of a ligament called plantar fascia.
The plantar fascia is a thick band of tissues that runs across the bottom of your feet between the toes and the heels. It connects your heel bone to the base of the toes.
Its anatomy ensures that it absorbs the impact on your feet when you walk, stand, dance, or run. The plantar fascia also gives the feet their natural arch.
However, plantar fasciitis develops when this ligament bears repetitive stress or excessive tension, causing wear and tear. The wear and tear of these tissues causes irritation and inflammation, leading to heel pain and stiffness.
Fasciitis means inflammation of the fascia. However, some experts believe that what actually happens to the plantar fascia is degeneration and not inflammation. They argue that the correct term is plantar fasciosis since microscopic investigation shows degeneration.
The body attempts to heal the injured tissue by mounting an inflammatory response. “That, technically, is the inflammation people talk about, meaning new blood flowing to try and heal the degenerative area,” says Sean Peden, an orthopedic foot and ankle surgeon at Yale Medicine.
What Causes Plantar Fasciitis?
Anatomically, the plantar fascia is designed to bear the weight that falls on our feet when we walk, stand, or do sporting activities. Over time, stress and strain accumulate and weaken this tissue.
So any activity or condition that strains the foot or causes it to bear more weight increases the risk of developing plantar fasciitis. That’s why athletes, especially long-distance runners, are mostly affected.
Among the non-athletic population, plantar fasciitis is linked to obesity and a lack of physical exercise.
In the same vein, pregnancy predisposes women to get plantar fasciitis since their feet bear extra weight during late pregnancy.
Risk Factors
In most cases, the exact cause of plantar fasciitis is not clear. But the identifiable risk factors are:
What are the Symptoms of Plantar Fasciitis?
A painful sensation in the heel, which may be dull or sharp, is the commonest symptom of plantar fasciitis. The pain develops gradually and becomes more acute in the morning when you take the first step out of bed. Or the first step you take after prolonged standing or sitting. No wonder it’s called first-step pain.
Patients say they don’t often experience any pains during an activity. The pain is more intense in bare feet or shoes with poor support.
People with this condition have limited dorsiflexion- dorsiflexion is a movement that brings the foot toward the shin. Having difficulty with dorsiflexion is one of the diagnostic criteria and increases the odds of getting Plantar Fasciitis by 23%.
Patients sometimes report clicking or snapping sounds around the heel, while numbness, tingling, and swelling are rarely reported.
Other symptoms include:
Diagnosis
Your painful heel may be a result of another foot problem. So a doctor will rule out plantar fasciitis based on medical history, risk factors, and clinical examination.
After describing your symptoms, the doctor will examine your foot for:
Though not necessary, your doctor may order an imaging test (X-ray or MRI) to rule out other possible causes of heel pain, such as bone fracture and heel spurs.
In the past, doctors wrongly attributed plantar fasciitis to heel spurs. A heel spur is a small bony outgrowth on the heel. However, most patients with heel spurs don’t experience heel pain.
Treatment
Though experts say plantar fasciitis is self-limited, more than 90% of patients will get well months after starting simple treatment. But that’s not true for all patients. At least, I have read some cases where patients say many treatments have failed.
One Toronto-based sports medicine specialist, Dr. Chris Woollam, admits some patients may have difficulty overcoming plantar fasciitis.
Family medicine experts Emily Schwartz and John Su say treatment is often difficult because the healing mechanism for chronic degeneration is not well understood.
On his part, “treatment is like making a cake, as I tell patients. It’s going to be a little bit of this, a little bit of that. And sometimes one thing works...” says Vancouver-based podiatrist Joseph Stern.
One thing is sure. Patients recover, and the treatment doesn’t fall outside what we currently know. So how can I treat my plantar fasciitis? Let’s go!
Rest
Plantar fasciitis is a foot issue linked to certain types of movement or activities. So it’s a no-brainer that resting from the actions that worsen your injury is the first remedy. For athletes, your trainer may recommend suspending the sports you love to do if it aggravates the symptoms.
Ice
Physical trainers recommend rolling the affected foot over ice or a cold water bottle for 20 minutes 3 to 4 times daily. You could use ice pads at home or ask your therapist to massage your foot with iced devices.
Ice helps reduce the pain and inflammation that accompany Plantar Fasciitis.
Physical Therapy
In part, plantar fasciitis is a movement issue; physical therapists are trained to correct this.
Your physical therapist may assess your movement to see how it affects your symptoms. Most physical therapy includes gait training to reduce symptoms and improve walking ability.
Since Plantar Fasciitis develops due to tight muscles in the feet and calves, physical therapists often prescribe stretching exercises to improve the flexibility of your ankle and fascia. In addition, strengthening exercises to improve muscle strength are usually included.
Shoes
In some patients, Plantar Fasciitis results from wearing shoes with soft soles and poor arch support, especially flat shoes with tiny soles.
The best shoes for Plantar Fasciitis reduce the tension on the fascia and provide foot and arch support. For runners, consider lightweight shoes with a good toe box in addition to the qualities mentioned earlier.
To ease your pain or even prevent Plantar Fasciitis, experts recommend wearing the proper footwear for walking and running.
Stretching
Tight muscles in your feet and calves aggravate Plantar Fasciitis. So stretching activities that improve the flexibility of these muscles help relieve pain. These exercises are designed to stretch your calf and fascia.
You may need a physical therapist to perform some stretching activities, and a good number is straightforward.
However, it’s better to continue these exercises if your symptoms improve after a few weeks to avoid re-injury.
Other treatments include night splints that stretch your fascia when you sleep and the use of NSAIDs and corticosteroids, depending on severity.
Very few patients might have surgery because non-surgical treatments work for most people. Doctors may recommend surgical treatment if there are no improvements after 12 months of non-surgical procedures.
The Bottomline
Plantar Fasciitis affects people of all ages but is common among athletes and active men and women above 40 years. It’s linked to structural foot issues like a high arch, flat foot, and limited dorsiflexion. Also, bad footwear are a risk factor, and symptoms improve with supportive footwear.
Most people will recover within 10 months of non-surgical treatment, but continuing these treatments reduces the chances of re-injury.
If you suspect you’ve Plantar Fasciitis, consult your doctor for diagnosis and suitable treatments.
Understanding the Plantar Fascia
A flat band of tissue joins the heel bone to the toes. This band of tissue is called the Plantar Fascia. ‘Itis’ is a suffix which means pain and inflammation. That’s why the painful inflammation of the Plantar Fascia is known as Plantar Fasciitis.
The Plantar Fascia is the ligament that supports the arch of your foot. To understand why people suffer from Plantar Fasciitis, it is important to understand how this ligament can get affected in our daily life.
Sources
Daniel L, et al. (2003). Risk factors for plantar fasciitis: a matched case-control study.
Emily N, et al. (2014). Plantar Fasciitis: A Concise Review.
Kristeen C, (2019). Everything You Need to Know About Heel Spurs.
Plantar Fasciitis Exercises.
Plantar Fasciitis.
Plantar Fasciitis and Bone Spurs.
The Canadian Press. (2014). Heel pain a classic sign of common foot injury.
