Plantar fasciitis is one of the most common causes of foot pain, accounting for the vast majority of heel pain cases. Many people think that it can’t be treated but that’s just not true. In fact, most people recover in less than 12 months, once they start treatment.
We look at how Plantar Fasciitis develops and how to tell if you are suffering from it, as well as what your treatment might look like.
How Plantar Fasciitis Develops
Evidence suggests that this condition arises from repeated micro-traumas to the plantar fascia over time. This makes it a chronic, degenerative, overuse condition. The term “Plantar Fasciitis” has fallen out of favour in recent times and is now more often referred to as “Plantar Fasciopathy”, as the former name suggests that some sort of inflammatory process is involved, which may not always be the case.
The Plantar Fascia
To understand the condition better, it’s useful to know why the Plantar Fascia is so important.
It’s is a tough, inelastic sheet of connective tissue that spans the underside of your foot between your heel and your toes. The Plantar Fascia plays a significant role in foot function, both when you’re standing and when you’re walking; especially during the final part of the contact phase of gait when your big toe is bending upwards and your heel is lifting off the ground.
It also plays an important role in securing and stabilising the inside arch of your foot (medial arch). Because it is inelastic, it resists being stretched, which means that it stores elastic energy during the initial weight bearing phase and returns it during the propulsion phase, acting a bit like a spring. This capacity of storing and releasing energy saves about 50% of the metabolic energy needed during this process.
The plantar fascia begins at the medial calcaneal tuberosity (a small bump underneath your heel bone) where its deep fibres attach to the bone itself, while its superficial fibres connect and merge with your Achilles tendon as well as the back part of the heel.
The plantar fascia is roughly triangular and narrowest at the portion that attaches to your heel. From there, it fans out, becoming broader and thinner until it attaches to the ball of your foot, or more specifically, to the plantar plate on the plantar aspect of the metatarsal heads. From here it splits into five small tendon slips which attach to the first bone of each toe. If you raise your big toe upward (dorsiflexion), the medial (inside) border of the plantar fascia will become tight under tension and will often be clearly visible, raising the arch of your foot by drawing the heel and the big toe joint (1st Metatarsal phalangeal joint) closer together. This is called “The Windlass Mechanism”. It is very important when you are walking and moving about.
How Will I know if I am Suffering from Plantar Fasciitis?
If you are suffering from Plantar fasciitis you may have the following symptoms:
- Heel pain that is worse when first standing in the morning
- Heel pain after sitting for a long time.
- Heel pain that increases after physical activity.
- Pain that is “burning”, “aching”, and occasionally as “stabbing”.
The first symptom is the most important. If you have no heel pain on first getting up in the morning or on first standing up after a period of sitting, then it is unlikely that you have Plantar Fasciitis. Other possible diagnoses would be a heel spur (bony outgrowth), a heel fracture, a trapped nerve of the first sacral nerve in the spine, and entrapment of the medial calcaneal nerve or the 1st branch of the lateral plantar nerve.
Causes of Plantar Fasciopathy
The underlying causes of Plantar Fasciopathy include over-use, over-training, being overweight, biomechanical changes to the foot or altered biomechanics, and doing activities that involve standing for a long time.
Treatment for Plantar Fasciopathy
- medical grade insoles
- footwear recommendations
- padding and strapping that directly or indirectly reduce the mechanical stresses on the affected tissues
and symptom-based therapies, such as
- pain medication
- ultrasound therapy
- steroid injections
Thankfully, the vast majority of people diagnosed with Plantar Fasciopathy recover in less than 12 months using only conservative treatments.
If you believe that you have Plantar Fasciitis, or any other foot condition, please make an appointment with our Podiatry team. We can offer a free 15 minute consultation to new clients and use that time to examine your lower limbs to begin determining what the issue is and what treatment plan we would advise.