Plantar fasciitis
The plantar fascia is a thick, strong band of tissue that runs from the bottom of the heel bone (calcaneus) to the toes and acts as an extension of the Achilles tendon. It is inelastic and plays an important role in maintaining the arch of the foot during gait and providing support.
Plantar fasciitis is characterised by a painful retraction of the plantar fascia with an in increase in curvature.
Symptoms
The typical symptom is a plantar pain in the heel, especially when taking the first steps in the morning or after sitting for a long time. The pain gradually improves with walking, only to worsen again at the end of the day.
Causes
Plantar fasciitis does not necessarily have a single cause. Several risk factors can increase a person’s chances of developing the condition. These include:
- age – most common between 40 and 60;
- exercise, such as running, that causes repetitive stress on the plantar fascia;
- flat feet, high arching of the feet or tightening of calf muscles;
- being overweight, obesity or pregnancy;
- arthritis;
- standing for long periods of time, often in high heels.
Women are more likely than men to suffer from this condition, either as a result of pregnancy or the wearing of inappropriate footwear.
Diagnosis
Diagnosis is essentially clinical, but weight-bearing x-rays, ultrasound and MRI are important tools to aid diagnosis by providing information on the condition of the plantar fascia and surrounding structures.
Medical diagnosis is based on an initial assessment in a physical and rehabilitation medicine or sports medicine consultation with an orthopaedist or one of our physiatrists.
Treatment
Resting and relieving foot pressure is the most effective treatment. Most cases are treated with non-surgical medical treatments, with surgery being reserved for situations where, despite treatment, satisfactory results are not obtained one year after the onset of the symptoms. Exercises begin gradually and progress until the patient fully recovers during the physiotherapy sessions.
Sometimes physicians also recommend the use of:
- orthotic devices such as fitted shoes, cushioned insoles and heel supports;
- a night splint: people usually sleep with their feet relaxed and pointing down. In this position, the heel relaxes and the plantar fascia and calf muscles contract, increasing pain in the foot’s arches. Using a night splint keeps the foot flexed, reducing tension in the muscles and fascia;
physiotherapy, which can help stretch the muscles to improve range of motion, reduce pain and inflammation, and aid healing; - anti-inflammatory treatment with corticosteroids in the fascia can reduce pain and inflammation.
The vast majority of patients (around 80-90 %) improve with this medical treatment over several months. If none of these treatments are effective, the physician may recommend having surgery. Although this is a low-risk surgery, complications such as pain and nerve damage can occur in some cases.
There are two main options:
Retracting the gastrocnemius muscle allows the calf muscles to stretch, increasing ankle range of motion and reducing stress on the plantar fascia. It is a minimally invasive procedure that can reduce recovery time.
Fasciectomy, where a cut is made in the fascia to reduce its tension. People with good range of motion in the ankle are the best candidates for this procedure.
Prevention
Warming up before starting any physical activity is essential. It is also important to maintain an appropriate level of activity without overdoing it or overexerting yourself.
Maintaining a healthy weight helps to reduce pressure on the heels.
If you need treatment for plantar fascitiis, contact our physiotherapy clinics in Lisbon.
