ALL YOU NEED TO KNOW ABOUT PLANTARFASCIITIS
a quick summary / All you need to know about plantarfasciitis / what causes plantarfasciitis / treatment options / orthotics
What is Plantarfascitiis?
Heel pain is a common presenting complaint in the foot and ankle practice, and plantar fasciitis (PF) is the most common cause of chronic pain beneath the heel in adults, making up 11–15% of the foot symptoms requiring professional care among adults (7).
1 in 10 people will develop plantarfasciitis in their lifetime (2). Studies have found incidences of plantarfasciitis to be higher amongst the following groups of people (2);
- Middle-aged over weight females
- Young male athletes
- The athletic population
A quick summary of plantarfasciitis
- Pain on the inside of the heel
- Most noticeable with initial steps after a period of inactivity
- Pain usually lessens with increasing level of activity during the day, but will tend to worsen toward the end of the day (6) .
- Pain worse following prolonged weight bearing, and often precipitated by increase in weight bearing activities.
- Usually present on one side only but can be present bilaterally in up to 30% of cases (3)
- Tightness of Achilles tendon is found in almost 80% of cases (4) it can taken between 6 – 18 months to resolve (1).
Plantarfasciitis has been described within scientific literature as (7,3);
- Painful heel syndrome
- Chronic plantar heel pain
- Heel spur syndrome
- Runner’s heel
- Calcaneal periostitis
What does plantarfasciitis feel like?
Plantarfasciitis causes pain beneath the heels. It is the most common reason patients come to see us in clinic, with many patients no longer able to participate in daily activities such as simple trips to the shops. The severity and duration of symptoms associated with plantarfasciitis vary greatly from person to person, with some symptoms resolving quickly whilst others can last years! The pain can be described as an ache or burning sensation under the heel of the foot and sometimes the pain can present under the arch of the foot and around the back of the heel. People describe that they suffer the most severe heel pain on those first few steps taken after getting out of bed in the morning. In the more mild cases the pain will ease after the first few steps and not often present through-out the remainder of the day. In the more severe cases people will describe the onset of heel pain when standing and walking following periods of non weight bearing, such as getting up out the chair or walking after driving. You may struggle with increasing pain in-line with increased walking: i.e. the pain gets worse the more you walk. In the most severe cases, heel pain presents at rest and can also keep you up at night.
The most unlucky sufferers of heel pain will struggle for months and sometimes years, making it all the more essential that you don’t ignore heel pain and instead you do take the simple steps to resolve plantarfasciitis as soon as you can. By doing so, you stand to prevent months of agonising pain, inability to participate in activity and daily life tasks, and sometimes the onset of associated depression.
What does plantarfasciitis look like?
Again, the severity of symptoms associated with plantarfasciitis vary from one person to the next. One may not notice any change in the appearance of the foot, however it is often the case that the underside of the heel (and sometimes also the underside of the middle of the foot and arch) is swollen and there may also be swelling around the medial aspect (inside) of the ankle, particularly if the ankle tendon is strained in relation to the plantarfasciitis. The heel of the affected foot may be a little red in appearance.
What is Plantarfasciitis?
The plantar fascia is a fibrous band that extends from the heel bone to the toes and acts as shock absorber, supporting the arch in your foot. The collagen fibres within the plantar fascia band are organised so that movement in the foot, such as going onto your toes, is enabled. Plantarfasciitis can be described as inflammation after injury of the plantar fascia band under the foot, resulting in pain under the heel at the insertion of the plantar fascia band. You may be able to bring on the pain when palpating under the heel and it is possible that you can feel a thickening here. The temptation is to massage this thickening however be careful, doing this could exacerbate the inflamed area and make the symptoms worse.
Plantarfasciitis is one of the most common musculoskeletal problems that podiatrists see. It is usually described as a hot, swollen and tender heel in the days after damage. When we walk we are constantly putting pressure on the plantar fascia and sometimes excessive pressure, such as starting a new sport or walking more regularly than before, can instigate the micro trauma of the plantar fascia. Recent weight gain can also play a major factor in the development of plantar fasciitis, thus explaining why we see many expectant mothers with recent onset of plantar fasciitis due to the excessive loading on the feet. Poor biomechanics such as a tight achilles tendon or over pronated (“flat feet”) can also play havoc on the plantar fascia, therefore it is advisable to have your foot posture and biomechanics checked.
Despite the high prevalence of plantarfasciitis, information about its pathogenesis is still limited, and its histological changes are suggestive of degeneration rather than inflammation (7). Plantarfasciitis which has been present for longer that 6 weeks can be described as Plantar fasciosis (degerneration). This is further more extensive damage to the plantar fascia band due to the repetitive application of abnormal stresses over this longer period of time. Plantar fasciosis occurs due to the deterioration of the integrity of the plantar fascia over time. By the time most patients see a clinician their condition has progressed from plantarfascitiis (inflammation) to the chronic, plantar fasciosis.
The two terms, plantar fasciosis and plantar fasciitis are very similar however plantar fasciitis could technically be confirmed as a short term injury to the area (plantar fascia) whereas plantar fasciosis is the longer term injury. That said, in general society here in the UK, we tend to lump the two terms together and monopolise the term Plantarfasciitis when describing injury to the plantar fascia, regardless of extent of the damage and length of time the injury has been present. Therefore, for the sake of an easier understanding, we will continue to describe injury to the plantar fascia as Plantarfasciitis throughout our site and on our blog and related articles.
Is a Bone Spur the same as Plantarfasciitis?
A bone spur is a build up of calcium deposits underneath the heel bone. The heel spur can protrude through the heels’ fat pad and be very painful on weight bearing.
Fibrocartilage is the strong, tough tissue containing cartilage which is found at the insertions of tendons and ligaments into a bone. Heel spurs have been found surrounding fibrocartilage of the heel which ay not be aligned with the same direction of traction (1).
If not plantarfasciitis, what else could the heel pain be?
- a plantar fascia rupture
- atrophy of the heels fat pad
- a stress fracture of the calcaneus (heel bone)
- tumor
- calcaneal bursistis
- Boxter’s Nerve Entrapment
- Medial Nalcaneal Nerve Entrapment
- Seonegative Arthropathies
- Spinal Stenosis and L5-S1 nerve irritations
(7)
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References sited:
- Hossain M, Makawana N. “Not Plantar Fasciitis”: The differential diagnosis and management of heel pain syndrome. Orthopaedics and Trauma. 2011. vol. 25(3), pp. 198–206.
- Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A:872–7.
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Roxas M. Plantar fasciitis: Diagnosis and therapeutic considerations. Altern Med Rev. 2005. vol. 10, pp. 83–93.
- Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ. 1997;315:172–5
- Stuber K, Kristmanson K. Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials. JCCA. 2006;50:118–33.
- McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain-plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1–18
- M.A. Tahririan, M.M. Mohammad, N. Tahmasebi, and B. Siavashi. 2012. Plantarfasciitis. J Res Med Sci. pp. 799–804.
