Plantar fasciitis

Plantar fasciitis

DEFINITION
Plantar fasciitis means inflammation of the plantar fascia, a
strong band of tissue (similar to a ligament) that stretches from
the heel to the middle bones of the foot.
DESCRIPTION
Plantar faciitis is the most common cause of heel pain. Small
injuries to the plantar fascia, which supports the arch of the
foot, can cause inflammation and pain. The injury is usually near
to where the plantar fascia attaches to the heel bone.
 
Heel Spur
Prolonged inflammation of the plantar fascia can result in the
development of a bony growth called a heel spur. In the past it was
thought that heel pain was caused by heel spurs which were removed
surgically. Doctors have since found that bone spurs are not
typically the cause of heel pain and surgery to remove spurs is
rare.
CAUSE
Plantar fasciitis is quite common. It mainly affects people
over 40 years of age. Other factors that increase the risk of
developing Plantar fasciitis include;
  • Occupations that require a lot of walking or standing on hard
    surfaces, including factory work, teaching, retail and hospitality
    work
  • Athletic activity that puts pressure on the heel e.g running,
    ballet and aerobics
  • Overuse or sudden stretching of the sole e.g increasing running
    intensity or distance
  • Wearing shoes with poor cushioning
  • Being overweight which can increase the amount of tension in
    the plantar fascia. Sudden gains in weight or being overweight can
    also break down the fatty tissue under the heel bone and cause heel
    pain. This is called ‘fat pad syndrome’.
  • High arches or flat feet
  • Tightness of the Achilles tendon (at the bottom of the calf
    muscles above the heel).
SIGNS AND SYMPTOMS
Plantar fasciitis usually develops gradually in one foot. Less
commonly it can affect both feet and have a sudden and severe
onset. Symptoms include:
  • Sharp pain anywhere on the underside of the heel
  • Heel pain that tends to be worse with the first few steps after
    awakening, when climbing stairs or when standing on tiptoe
  • Heel pain after long periods of standing or after getting up
    from a seated position
  • Heel pain after, but not usually during, exercise
  • Mild swelling of the heel. 
TREATMENT OPTIONS
As with all medical conditions see your Doctor for an accurate
diagnosis and treatment. Your Doctor will ask you about your
symptoms and look for points of tenderness in your foot. This can
help rule out other causes of heel pain, such as tendinitis,
arthritis, nerve irritation or a cyst. Your Doctor may also suggest
an X-ray or magnetic resonance imaging (MRI) to ensure you do not
have a stress fracture. When the cause of your heel pain is
identified and managed the pain will usually ease over several
months. The following measures may help to speed up the recovery
process.
  • Rest the foot as much as possible.
  • Choose shoes with cushioned heels and a good arch support.
  • Use heel pads or custom-fitted arch supports (orthotics) in
    your shoes to cushion the heel.
  • Pain relief such as paracetamol will help to ease the pain.
    Anti-inflammatory medication such as ibuprofen may be useful. Your
    doctor may suggest one or two injections of corticosteroid
    medication into the region of the plantar fascia attachment at the
    heel for temporary relief.
  • Strapping or taping the arch of the foot may be helpful either
    as a treatment measure or to determine if arch supports or
    orthotics will be beneficial.
  • An ice pack can help to relieve pain by reducing inflammation.
    It is advisable to apply the ice pack to the heel for 15 to 20
    minutes after exercise or daily activities.
  • Your Doctor may refer you to a Physiotherapist to instruct you
    in a series of exercises to stretch the plantar fascia and Achilles
    tendon and to strengthen foot muscles and muscles in the lower leg
    which stabilise your ankle and heel.
  • Your Doctor may recommend wearing a splint fitted to your calf
    and foot while you sleep. This holds the plantar fascia and
    Achilles tendon in a lengthened position overnight so that they can
    be stretched more effectively.
  • In a small percentage of people surgery may be required to
    detach the plantar fascia from the heel bone. It is generally an
    option only when the pain is severe and all else fails. Side
    effects include a weakening of the arch in your foot.
PHARMACIST’S ADVICE
  1. Rest your affected foot as much as possible. 
  2. Ask your Pharmacist to recommend a suitable type of heel pad or
    heel cup to insert into your shoe.
  3. Ask your Pharmacist about some anti-inflammatory and pain
    relieving medication that may provide some temporary relief from
    heel pain. 
  4. Applying an ice pack to the painful area can help to relieve
    pain by reducing inflammation. A flexible cold pack from your
    Pharmacy or crushed ice in a plastic bag wrapped in a towel makes
    the best ice pack, because these can be moulded to the foot,
    increasing the contact area.
  5. Ask your Pharmacist to demonstrate the correct method for
    strapping or taping the arch of the foot
  6. Follow any stretching and strengthening exercises recommended
    by your Physiotherapist e.g practise picking up a towel off the
    ground with your toes. 
  7. Wear protective shoes when playing sport or when walking. This
    will support the heel and help to prevent jarring.
  8. Being overweight may worsen the severity of Plantar fasciitis.
    Ask your Pharmacist for advice about how to lose weight.