
My foot is flat. Is that a problem?
September 4, 2019
Asia Pacific Orthopaedic Association Meeting, Bangkok, September 2019
September 23, 2019Plantar fasciitis – is it a lifelong sentence?
One of the major causes of a chronic heel pain is plantar fasciitis. It is a common foot condition that is typically associated with sporting activity. Most times, it occursin association with a recent history of frequent and long distance running, jumping exercises or even high-intensity interval training.

Plantar fasciitis causes a severe stabbing pain in the bottom of the foot beside the heel. A band of deep tissue that runs from your heel bone to your toes is called the plantar fascia.It is a tight band of supportive tissue that supports the arch of your foot and also acts as shock absorber. A tear or injury to this tissue may precipitate inflammation, resulting in plantar fasciitis. The damage that happens to this tissue is caused by overuse and / or repetitive loading.

It is estimated that about 10 percent of people will have plantar fasciitisat some point in their life.You need to know more about this injury to understand what you are dealing with. I’m going to ponder next on the symptoms of plantar fasciitis.
What are the symptoms of plantar fasciitis?
Plantar fasciitis is one of the commonest orthopedic problems patients present with. The symptoms associated with plantar fasciitis usually involve the sole. You may feel some pain in the middle of the foot or more likely around the heel. The pain gets intense over time. Most times, it affects only one foot. However, it can also affect both feet simultaneously.
The following are the observable symptoms of plantar fasciitis.
- Some people experience a dull, sharp or burning pain at the bottom at the heel.

- Severe pain in the heel and tenderness at the sole of the foot.
- This severe pain in the heels makes it difficult to bear weight on the affected foot. Thus, walking may become more difficult when you take the first few steps in the morning or if you are sitting/lying for a prolonged period and then rise up to walk.

- If the plantar fascia ligament is given too much stress, the pain can get worse as a result of increased inflammation (swelling).

You don’t usually feel pain during activity. The pain often starts just after exercise.( when the soft tissues start to tighten up )
What are the causes of plantar fasciitis?
The cause of plantar fasciitis is not entirely clear. However, clinical studies have consistently highlighted strong associations that appear to contribute if not directly result in plantar fasciitis.
Being overweight or obese means you are at a higher risk of developing plantar fasciitis. The excess weight puts massive pressure on your plantar fascia ligaments. This extra load renders a torn plantar fascia less likely to heal nor for an inflamed plantar fascia to self-resolve. During the late period of pregnancy, pregnant women have added weight which in turn renders them more prone to plantar fasciitis during late pregnancy.

As an endurance runner, you are at risk of developing plantar fasciitis. If your job requires you to stand on your feet for a prolonged period, for example, working as a receptionist, you are also at risk.

People between the ages of 40 and 70 are also at higher risk of developing plantar fasciitis. This condition seems to have a higher prevalence in women rather than men. Hormonal differences between the genders may account for this.

Flatfoot syndrome has a strong association with plantar fasciitis. Patients with flatfeet typically have tight plantar fascialbands which are more likely to tear, or get inflamed. Customized orthotics with a supportive arch is essential to reduce the likelihood of this condition recurring.

Plantar fasciitis is not a long life sentence
Are you someone who has plantar fasciitis and are you concerned this may be a permanent feature ? Don’t worry; I’ve got good news for you. Plantar fasciitis is not a long life sentence. The pains will disappear, and you will get to enjoy a pain-free lifestyle as soon as your treatment begins.
Plantar fasciitis is a self-limiting condition. It usually heals within a time range of 6 to 18 months without treatment. However, you can gain up to 90% recovery within six months of consistent non-operative treatment.
Plantar fasciitis treatments
We are going to look at some procedures which can facilitate relief and full recovery of plantar fasciitis.
Treating plantar fasciitis at home
The RICE therapy – when you notice the symptoms of plantar fasciitis for the first time. The typical first aid you practice is commonly known as RICE treatment.
- Rest – rest the affected area for up to 2 to 3 days.

- Ice – apply ice to the affected area for about 10 to 25 minutes of the first 2 or 3 days.

- Compression – compress the affected area with a bandage or soft wrap to prevent further damage or swelling.

- Elevation – ensure that the affected area is elevated by supporting it with few pillows to prevent further swelling.

Proper footwear with orthotics / heel pads
Proper arch supports for your footwear will help eliminate some of the pain you are feeling. They help to prevent further damage to the plantar fascia.

Braces such as night splints help to stretch your calf and the arch of your foot. They increase the length of your plantar fascia and Achilles tendon overnight. This action can prevent pain and stiffness when you rise out of bed in the morning.

Medication with anti-inflammatory drugs
To reduce pains and inflammation, Non-steroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin IB, and more) are examples of drugs that can reduce the inflammation to begin with.
Therapies
- Physical Therapy – this is an essential part of treatment for plantar fasciitis. This treatment helps to stretch your plantar fascia ligament and Achilles’ tendon. With the help of a physiotherapist, you can be taught different exercises. These exercises help to strengthen the muscles of your lower leg, which in turn stabilizes your walk and reduces pressure on your plantar fascia.

- Extracorporeal shockwave therapy (EST)– this therapy involves the bombardment of sound waves to your heel to stimulate rapid healing within the ligament.

- Acupuncture therapy
- Cortisone injections

Surgery
As with most conditions, surgery for recalcitrant plantar fasciitis is the last resort. Between 3-5% of all patients may end up requiring surgery, usually after prolonged and failed conservative therapy and worsening symptoms. Surgery helps to reverse the underlying biomechanical problem – the tight calf muscles and the tight plantar fascia. Surgical release can be done through small key-holes and the patient is walking from Day 1 with a supportive sandal. There is usually significant relief within the first 4 weeks even in this recalcitrant group of patients.
