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Plantar Fasciitis

Also referred to as plantar fasciopathy or jogger’s heel, plantar fasciitis is a common disorder that affects the underside of the foot and the heel and is characterized by pain. This disorder is also accompanied by inflammation, scarring and the plantar fascia structural breakdown. Plantar fasciitis is mostly caused by age, exercise increased weight and injury resulting from overuse. Initially, plantar fasciitis was believed to be a condition following an inflammatory process but recent studies have indicated that the degenerative process is involved. Because of this finding, there are many medical scientists suggesting the renaming of the condition to plantar fasciosis. So far, plantar fasciitis remains the most common injury involving the plantar fascia and is the most common cause behind heel pain. About 10 percent of people will suffer from plantar fasciitis at one point in their life. This condition is associated with long standing durations and is more common in people with excessive inward rolling of the foot which is mostly seen in flat feet. In the non-athletic population, this condition is mostly associated with a lack of exercise and obesity. The pain felt in the heel is mostly experienced in the bottom of the heel and is most intense when the person makes the first step of the day. Plantar fasciitis patients will have trouble with the dorsiflexion of their foot, which is the action involving the bringing of the foot towards the shin. The involved trouble is based on the fact that the Achilles tendon or the calf muscle are tight and restrict this and other types of movements. Most cases of a plantar fasciitis are self-limiting and will resolve on their own and some will respond well to conservative treatment methods.

Signs and Symptoms of Plantar Fasciitis

The pain associated with plantar fasciitis is typically sharp and unilateral in about 70% of the cases. The heel pain will worsen when standing for a long period of time or when bearing weight.  People suffering from plantar fasciitis will report their first steps of the day as having the most intense heel pain and also after sitting for long periods. The improvement of the symptoms is experienced through continued walking. Though rare, some patients have reported swelling, tingling, radiating pain and numbness. When the plantar fascia is overused in the presence of the plantar fasciitis, there is a possibility of a plantar fascia rupture. Typically, the symptoms of this condition will include a snapping or clicking sound, local swelling and acute pain perceived in the sole of the foot.

Risk Factors There are factors that are identified to increase the risk of developing plantar fasciitis. These factors include standing on a hard surface for a long period of time, excessive running, leg length inequality, flat feet and high arches of the feet. Flat feet have a tendency of rolling inward excessively during a walk or a run and this is what puts them at a greater risk of plantar fasciitis. Obesity is an independent risk factor and has been observed in about 70% of individuals suffering from plantar fasciitis. Studies involving the non-athletic population have indicated a strong connection between body mass index increase and plantar fasciitis development. This association has not been observed in the athletic population. Inappropriate footwear and the tightening of the Achilles tendon are also possible risk factors of plantar fasciitis.

Causes of Plantar Fasciitis

The cause behind plantar fasciitis is not clearly understood and is believed to have a number of contributing factors. Initially this disorder was thought to be a condition associated with inflammation of the plantar fascia. Over the last decade, studies have indicated that the condition is a non-inflammatory disorder involving the structural breakdown of the fascia. The breakdown is believed to be as a result of small tears referred to as repetitive microtrauma. Microscopic examinations of the plantar fascia will reveal calcium deposits in the connective tissues, disorganized collagen fibers and myxomatous degeneration. When there is excess strain on the calcaneal tuberosity caused by disruption of the normal mechanical movement of the plantar fascia during walking and standing, this is believed to cause plantar fasciitis. Here are studies that have indicated that plantar fasciitis might not be caused by the inflammation of the plantar fascia, but by a tendon injury associated with the flexor digitorum brevis muscle which is located near the plantar fascia.

Diagnosis of Plantar Fasciitis

The diagnosis process will involve the consideration of the patients’ history, clinical examination and the risk factors involved. The physical examination might include the tenderness palpation along the inside part of the heel bone on the foot’s sole. There is no need for diagnostic imaging in matters revolving around plantar fasciitis. However, imaging studies may be used in some cases when the physician wants to rule out any serious condition that may be causing the heel pain. In this case, the imaging studies used will include x-rays, MRI or diagnostic ultrasound.

Plantar Fasciitis Treatment

About 9 out of 10 cases of plantar fasciitis are self-limiting. This means that the condition and its symptoms will go away over time mostly about half a year with conservative treatment and within one year regardless of there being treatment or not. There are any different treatment directions that have been proposed for the management of plantar fasciitis. There is little evidence supporting the use of these treatment methods and thus most will not be recommended. Conservative treatment methods that are considered first line include the use of heat, ice rest, calf muscle stretching techniques, calf strengthening, weight reduction in case of obesity, and the use of NSAIDs such as ibuprofen and aspirin. Though non-steroidal anti-inflammatory drugs are commonly used in the treatment of plantar fasciitis, they fail to resolve the pain in about 20% of the patients. Corticosteroid injections are also used to manage this condition. When conservative methods are not effective in treating plantar fasciitis, surgery is recommended. The procedure involves a minimally invasive approaches and a more than ¾ of the patients that have undergone the surgical procedures have experienced full relief and have gone back to their normal activities.    

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