Plantar Fasciitis (PLAN-tur fas-e-i-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).
Symptoms
Plantar Fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worse in the morning following the first few steps after waking. The pain will normally decrease as you move about. It can also be triggered by long periods of standing or rising from sitting, and after exercise, not during it.
Causes
Under normal circumstances, your Plantar Fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of Plantar Fasciitis, the cause isn’t clear.
Risk factors
Though Plantar Fasciitis can arise without an obvious cause, factors that can increase your risks include:
- Age. Plantar Fasciitis is most common between the ages of 40 and 60.
- Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue, such as long-distance running, ballistic jumping activities, ballet dancing and aerobic dance.
- Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you’re standing.
- Inadequate Footwear. Try not to wear loose, ill fitting shoes. Wear something with some ankle support.
- Obesity. Excess weight puts extra stress on your Plantar Fascia.
- Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their Plantar Fascia. Try to wear footwear that has soles with some cushioning effect .
Complications
Ignoring Plantar Fasciitis may result in chronic heel pain that hinders your regular activities. Changing the way you walk to minimize Plantar Fasciitis pain might lead to foot, knee, hip or back problems.
Diagnosis
The diagnosis is made based on the medical history and physical examination. During the examination your doctor will check for areas of tenderness in your foot. Where your pain is situated can help determine its cause.
Imaging tests
Usually no tests are necessary. Your doctor might suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn’t being caused by another problem, such as a stress fracture or a pinched nerve.
Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.
Treatment
Most people who have Plantar Fasciitis recover with conservative treatments, including resting, icing the painful area and stretching, in several months.
Medications
Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can ease the pain and inflammation.
Therapies
Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include:
- Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the Plantar Fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
- Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the Plantar Fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
- Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.
Surgical or other procedures
When more-conservative measures aren’t working after several months, your doctor might recommend:
- Injections. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren’t recommended because they can weaken your Plantar Fascia and possibly cause it to rupture. More recently, platelet-rich plasma has been used, under ultrasound guidance, to provide pain relief with less risk of tissue rupture.
- Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic Plantar Fasciitis that hasn’t responded to more-conservative treatments. This procedure might cause bruising, swelling, pain, numbness or tingling. Some studies show promising results, but it hasn’t been shown to be consistently effective.
- Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It’s generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.
Lifestyle and home remedies
To reduce the pain of Plantar Fasciitis, try these self-care tips:
- Maintain a healthy weight. Lose weight if you’re overweight or obese to minimize stress on your plantar fascia.
- Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don’t go barefoot, especially on hard surfaces.
- Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 400 to 500 miles of use.
- Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging.
- Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.
- Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.
Here are some simple exercises that can help…
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