Understanding Plantar Fasciitis: Causes, Symptoms, and Treatment Options
Plantar fasciitis is one of the most common causes of heel pain, affecting individuals of all activity levels, from top athletes to weekend warriors. This condition results from stress and microtears in the plantar fascia, a thick band of tissue that supports the arch of the foot. Understanding its causes, symptoms, and treatment options can help individuals manage pain effectively and prevent further complications.
What is Plantar Fasciitis?
Plantar fasciitis is a degenerative condition rather than an inflammatory one, often referred to as plantar fasciopathy. It develops due to repetitive strain or overuse, leading to microtears in the plantar fascia, causing pain and stiffness. Despite its association with inflammation, research suggests that plantar fasciitis is primarily a degenerative disorder.
Causes and Risk Factors
Several factors contribute to the development of plantar fasciitis, including:
Repetitive stress: Activities such as running, prolonged standing, and high-impact sports increase the risk.
Biomechanical abnormalities: Flat feet, high arches, or a tight Achilles tendon may contribute to excessive strain.
Limited ankle dorsiflexion: Restricted ankle mobility may place additional stress on the plantar fascia.
Obesity: Excess weight increases the load on the feet, leading to strain on the fascia.
Symptoms of Plantar Fasciitis
The hallmark symptom of plantar fasciitis is sharp, stabbing pain in the heel, particularly:
In the morning: Pain is often most severe with the first few steps after waking up.
After rest: Symptoms worsen after periods of inactivity but may improve with movement.
Near the heel: Pain is usually localized to the medial aspect of the heel.
Association with calcaneal spurs: While heel spurs are often present, they are not necessarily the cause of pain.
Diagnosis is primarily based on clinical evaluation, including a physical exam and assessment of symptoms. In persistent cases, imaging techniques such as ultrasound or MRI may be used to rule out other conditions.
Treatment Options
Most cases of plantar fasciitis can be successfully managed with conservative treatments. Here are the most effective strategies:
Nonsurgical Treatments
Rest and Activity Modification: Reducing activities that stress the plantar fascia helps alleviate symptoms. This is recommended in the early stages of plantar fasciitis, and as your treatment plan progresses, it’s recommended to gradually re-load the plantar fascia to rebuild tolerance to your favoured activities.
Weight loss: Research suggests that obesity is a significant risk factor for developing plantar fasciitis, as it contributes to increased foot pressure and biomechanical imbalances. By losing weight, individuals can reduce the strain on their feet, leading to less pain and improved healing.
Stretching and Strengthening Exercises: Targeted exercises will aim to improve flexibility of the ankle and foot and strength of the muscles and tendons surrounding the plantar fascia. This will reduce strain on the fascia and lead to better long term outcomes. When you book an appointment with us, tailored exercises will be provided to ensure you are effectively loading the correct areas.
Orthotic Devices and taping: Custom or off-the-shelf arch supports and heel cups can provide cushioning and support. Contoured insoles and taping techniques provide short-term relief and improved function.
Night Splints: Wearing splints overnight helps maintain foot dorsiflexion, reducing morning pain. There is strong evidence to suggest night splints are useful for the treatment of chronic plantar fasciitis.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain in the initial stages of this condition. It is not recommended to use NSAIDs for long term management.
Manual Therapy: Techniques such as shock wave therapy and therapeutic ultrasound can aid in recovery. Additionally, manual therapy performed by a chiropractor can improve joint mobility at the ankle and surrounding regions, which may assist in the management and relief of plantar fasciitis.
Injections: Corticosteroid or platelet-rich plasma (PRP) injections can provide pain relief in stubborn cases.
In rare and more chronic cases, surgery may be required to release tension in the fascia, however this is generally only recommended once more conservative approaches have failed.
Plantar fasciitis is a prevalent and often painful condition, but with proper treatment, most individuals experience significant improvement. Approximately 90% of cases respond well to conservative management. Addressing biomechanical factors, incorporating stretching and strengthening exercises, and using supportive devices can help prevent recurrence. For stubborn cases, more advanced treatments are available to restore mobility and alleviate pain effectively. By understanding the degenerative nature of plantar fasciitis and tailoring treatment approaches to individual needs, long-term relief is achievable. If you’re struggling with persistent heel pain, consult one of our chiropractors for a comprehensive treatment plan.
References:
Cutts, S., Obi, N., Pasapula, C., & Chan, W. (2012). Plantar fasciitis. Annals of The Royal College of Surgeons of England, 94, 539 - 542. https://doi.org/10.1308/003588412X13171221592456.
El-Feky, M., & Schubert, R. (2004). Plantar fasciitis. Postgraduate Medicine, 116, 66 - 66. https://doi.org/10.3810/pgm.2004.09.1592.
Desnantyo, A. (2024). Controversies of the Plantar Fasciitis. Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/2325967124s00374.
Neufeld, S., & Cerrato, R. (2008). Plantar Fasciitis: Evaluation and Treatment. Journal of the American Academy of Orthopaedic Surgeons, 16, 338–346. https://doi.org/10.5435/00124635-200806000-00006.
Orchard, J. (2012). Plantar fasciitis. BMJ : British Medical Journal, 345. https://doi.org/10.1136/bmj.e6603.
Cornwall, M., & Mcpoil, T. (1999). Plantar fasciitis: etiology and treatment.. The Journal of orthopaedic and sports physical therapy, 29 12, 756-60 . https://doi.org/10.2519/JOSPT.1999.29.12.756.
Goff, J., & Crawford, R. (2011). Diagnosis and treatment of plantar fasciitis.. American family physician, 84 6, 676-82 .
Young, C., Rutherford, D., & Niedfeldt, M. (2001). Treatment of plantar fasciitis.. American family physician, 63 3, 467-74, 477-8 .
Hasegawa, M., Urits, I., Orhurhu, V., Orhurhu, M., Brinkman, J., Giacomazzi, S., Foster, L., Manchikanti, L., Kaye, A., Kaye, R., & Viswanath, O. (2020). Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review. Current Pain and Headache Reports, 24, 1-11. https://doi.org/10.1007/s11916-020-00883-7.
Mahindra, P., Yamin, M., Selhi, H., Singla, S., & Soni, A. (2016). Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.. Orthopedics, 39 2, e285-9 . https://doi.org/10.3928/01477447-20160222-01.
Song, Y. (2024). A Review of Common Interventions and Preventive Options Used in the Treatment of Plantar Fasciitis. Transactions on Materials, Biotechnology and Life Sciences. https://doi.org/10.62051/0807dh43.
Schuitema, D., Greve, C., Postema, K., Dekker, R., & Hijmans, J. (2020). Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review.. Journal of sport rehabilitation, 1-18 . https://doi.org/10.1123/JSR.2019-0036.
