Plantar Fasciitis: What causes heel pain and how to treat it?

Stabbing pain at the bottom of your heel can mean that you are suffering from plantar fasciitis. The pain is worse in the morning, as soon as you wake up and step out of your bed. However, standing for long periods can also aggravate the symptoms. Besides the bottom of your feet, you may also experience pain along the sole of your foot. There might be mild swelling or redness too. While severe cases of plantar fasciitis may need surgery, there are also home treatments that can make you feel better if you have mild plantar fasciitis. Let us learn more about this condition!

What is plantar fasciitis?

Plantar fasciitis is a common musculoskeletal disorder characterised by inflammation of the plantar fascia, which is a thick and fibrous band of connective tissue. This tissue band runs along the bottom of the foot, and it connects the heel bone to the toes. “It plays a crucial role in supporting the arch of the foot and absorbing shock during walking and running. This condition typically results in heel pain and stiffness, especially during the first steps in the morning or after periods of inactivity,” explains physiotherapist and sports medicine practitioner Prof. (Dr.) Ali Irani.

Symptoms of plantar fasciitis

There are some tell-tale signs of Plantar fasciitis, which must be noted for timely diagnosis. These are as follows:

• Heel Pain: Sharp, stabbing pain in the bottom of the foot near the heel.
• Morning Pain: Increased pain with the first steps in the morning or after long periods of sitting or lying down.
• Activity-related pain: Pain that intensifies after prolonged activity or exercise.
• Swelling: Mild swelling or inflammation around the heel.
• Stiffness: Reduced flexibility and stiffness in the foot, particularly in the morning.

Causes of plantar fasciitis

Here are the multiple reasons why you may have Plantar fasciitis:

1. Overuse of the area

Repetitive stress and overuse from activities such as running, walking, or standing for long periods, particularly on hard surfaces can lead to a case of Plantar fasciitis. A study published in Cureus states that Plantar fasciitis is the most common cause of arch pain as well as foot injuries in runners. It depends on the years of running, the kilometres covered in a week, and the runner’s height.

2. Biomechanical factors

Abnormal foot mechanics, such as flat feet, high arches, or an abnormal gait, can place excessive strain on the plantar fascia. Flat feet result in the loss of a foot arch, and this can increase the probability of plantar fascia, as it might lead to its prolonged stretching, states this study, published in the International Journal of Environmental Research and Public. High arch foot posture can result in poor shock absorption by the plantar fascia.

3. Age

Changes in plantar fascia are more common in people who are 40 years to 60 years old, states this study, published by the National Institutes of Health. It is seen in more women than men in the ages of 45 years to 64 years. This is because plantar fascia is a degenerative process. Also, tissue granulation and micro tears can lead to plantar fascia, and these occur with age.

4. Obesity

Excess body weight increases the mechanical load on the plantar fascia. A study, published in Foot & Ankle Orthopaedics, states that patients with significantly higher BMI reported painful plantar fascia. There were more chances of a plantar calcaneal bone spur, or heel pain, in obese people.

5. Occupational Risks

Jobs that require prolonged standing or walking, especially on hard surfaces, can contribute to the development of plantar fasciitis, states this study, published by the National Institutes of Health. This is why it is essential that if your job requires you to stand all day, you squeeze in breaks to help your feet relax.

How to diagnose plantar fasciitis?

There are a few ways that plantar fasciitis can be diagnosed. The doctor would first start with a clinical examination of your foot. This is an assessment of the foot for areas of tenderness, particularly in the heel and along the arch. There are some tests that he may perform as well. The Windlass test is a big toe extension test on a planted foot. This helps to determine the plantar fascia tightness.

The doctor will also ask for a detailed history of symptoms, recent changes in physical activity, and any underlying medical conditions. Multiple blood tests including Vitamin B12, D, Magnesium levels, and uric acid levels will be performed. X-rays will also be done to rule out other causes of heel pain, such as fractures or arthritis. An MRI may be considered if the diagnosis is unclear or if there are symptoms of other foot conditions.

Treatment of plantar fasciitis

There are some non-surgical treatments that you can try at home which will give you relief:

• Rest: Avoid activities that exacerbate heel pain.
• Ice Application: Apply ice to the affected area for 15-20 minutes several times a day to reduce inflammation and pain.
• Medications: NSAIDs, such as ibuprofen or naproxen, to alleviate pain and reduce inflammation.
• Orthotic Devices: Custom or over-the-counter arch supports and heel cups to distribute pressure more evenly across the foot.
• Physical Therapy: Stretching exercises for the Achilles tendon and plantar fascia, as well as strengthening exercises for the lower leg muscles. Calf raises, foot gym, intrinsic foot muscle exercises like – marble picking, curling toes, walking with curl toes, tennis ball rolling, and single leg balancing are few exercises to improve foot biomechanics.

The surgical treatments include a plantar fascia release. This is a surgical procedure to partially cut the plantar fascia to relieve tension and inflammation. Then, the doctor can also do a Gastrocnemius Recession. This is the lengthening of the calf muscles to reduce stress on the plantar fascia, usually recommended when tight calf muscles contribute to the condition.

Plantar fasciitis exercises for heel pain

How long does it take to recover from plantar fasciitis?

Recovery time varies depending on the severity of the condition and the treatment offered. You are sure to see a change within a few months, with proper treatment. However, chronic cases may take more time They can take up to 6-12 months for full recovery.

How to prevent plantar fasciitis?

There are some easy and practical ways to prevent plantar fasciitis.

• Proper footwear: Wear shoes that provide adequate support and cushioning.
• Maintain healthy weight: Reducing excess weight minimizes the strain on the plantar fascia.
• Regular stretching: Incorporate stretching exercises for the Achilles tendon and plantar fascia into your routine.
• Avoid high-impact activities: Limit activities that put excessive stress on the heels. Also, make sure to take breaks if you have to do these activities.
• Gradual Increase in activity: Increase physical activity levels gradually to avoid sudden stress on the plantar fascia.
• Use orthotics: Consider using arch supports or orthotic devices if you have flat feet or high arches. This would help alleviate the pain.
• Check uric acid and magnesium levels periodically as gout can lead to the formation of painful crystals around your joints.

How is plantar fasciitis different from heel spurs?

Plantar Fasciitis involves the inflammation of the plantar fascia and this leads to pain primarily in the heel, especially when you walk in the morning. However, a heel spurs its bony growth under your heel bone. Heel spurs may or may not cause pain, whereas plantar fasciitis typically results in significant discomfort. However, if a heel spur is painful, the pain will continue with every step. Plantar fasciitis is painful for the first few steps and then resolves as the walk is continued. The pain decreases as the plantar fascia is stretched gradually.

Summary

Plantar Fasciitis can lead to persistent heel pain that usually is worse as you take the first steps every morning. If not treated, it can lead to the development of heel spurs as well. Obesity, prolonged standing as well as age increases the risk of Plantar Fasciitis, and there are many surgical as well as non-surgical treatments to help with this condition.