Plantar Fasciitis – The Cause of Heel Pain in Adults

Background 

The plantar fascia is a broad band of connective tissue located along the bottom surface of the foot that runs from the heel bone (calcaneus) to the forefoot (metatarsals). Plantar fasciitis is a common clinical condition caused by overuse or acute injury direct to the plantar fascia. Inflammation, thickening, and a decreased blood supply of the fascia occur, causing symptoms of heel pain. The plantar fascia acts as a rubber band to absorb shock as you walk or stand and constantly elongates and contracts. This constant stretching can result in tears in the soft tissue, most commonly occuring at the heel. This condition is clinically referred to as plantar fasciitis/fasciosis 

Symptoms of plantar fasciitis/fasciosis  

Symptoms may include:

  • Burning sensations in the sole of the foot
  • Recurring foot pain that is especially sore or tight in the morning or after sitting.
  • Tired feet after being upright for long periods of time
  • Heel pain after beginning a new exercise routine
  • Pain that increases over a period of months

Causes of plantar fasciitis/fasciosis   

Heel and arch pain is usually the result of abnormal biomechanics (function) that place too much stress on the heel bone and the soft tissues that attach to it. Other causes include sudden increases in physical activity leading to excessive stresses, which the plantar fascia may not be conditioned to withstand at the time. The increased stress causes local inflammation and pain.

There are numerous conditions that cause heel pain, and symptoms of one condition can be similar to that of another. Therefore it is vital that an accurate diagnosis is made by a podiatrist, in order for treatments to be affective. Some other common causes of heel pain include:

  • Fat pad syndrome
  • Baxter’s Nerve Entrapment
  • Tarsal tunnel syndrome
  • Achilles Tendonitis
  • Calcaneal (heel bone) fracture
  • Retrocalcaneal bursitis

Conservative Treatment 

A comprehensive clinical examination of the affected foot is undertaken to assess for possible causative and aggravating factors, the severity of the condition, and suitable treatment options. Diagnostic imaging such as X-rays and Ultrasound may also be ordered.  

From these findings, a treatment plan is developed specifically to you. Some aspects of the treatment plan may include:

  • Rest – Avoid activities that cause or aggravate symptoms to prevents further injury and promote healing.
  • Ice – to ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
  • Anti-inflammatory – Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofennaproxen, or aspirin, will help with pain and swelling.
  • Physical therapy – Exercises, stretching and proprioceptive training may also be prescribed to stabilise the foot and reduce the cause of symptoms.
  • Injection therapy – Injections of a local anaesthetic can provide pain relief, and an injected corticosteroid may be useful in treating the inflammation. Prolotherapy has also been found to provide effective pain relief in some cases.
  • Orthotic therapy – A custom orthotic device placed in the shoe can help address possible causative factors such as flat feet, to reduce stress on the plantar fascia.
  • Extra Corporeal Shockwave Therapy – A non-invasive treatment where shockwaves are sent into the foot to stimulate the body’s own healing process.
  • Adequate footwear – Supportive footwear may also be recommended to stabilise the foot and ankle.
  • Taping/Bracing – Taping or bracing can help to stabilise the foot and ankle and reduce excessive stress on the plantar fascia.
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