Plantar fasciitis is a disease of the plantar fascia of the foot. It particularly affects overweight people and running athletes.
What is plantar fasciitis?
Plantar fascia (aponeurosis plantaris’) is a tendon plate located on the lower side of the foot. It extends from the heel to the front ball of the foot. The plantar fascia has the function of ensuring the longitudinal arch of the foot. At the same time, it counteracts a lowering of the arch of the foot. If a disease of the plantar fascia occurs, physicians speak of plantar fasciitis. Pain occurs on the sole of the foot and at the transition to the heel. Plantar fasciitis is considered the most common trigger of pain in the heel area. Around 10 percent of all people are affected by this foot condition at some point in their lives. The disease is more common in women than in men. The frequency of plantar fasciitis also depends on the body mass index and the age of the affected person. In addition, about 70 percent of all patients suffer from obesity.
Causes
Plantar fasciitis is mostly caused by inflammation. However, overuse of the plantar fascia can also be responsible for the condition. The inflammation of the aponeurosis plantaris is caused by the permanent irritation of the tendon plate. The development of plantar fasciitis is favored by foot malpositions, weak foot muscles or muscular imbalances. Plantar fasciitis often occurs in running athletes who suffer from flat feet. Thus, the flat foot causes constant overstretching of the aponeurosis plantaris. This leads to overstimulation and, in the further course, to inflammation of the plantar fascia. A similar thing happens in runners with a hollow foot. Without a longer recovery period, there is a risk of a chronic pain condition. Also frequently affected by plantar fascia are people with different leg lengths or severely overweight individuals. It is also not uncommon for the foot condition to occur in people who have to perform standing activities for long periods of time.
Symptoms, complaints and signs
Plantar fasciitis is noticeable by pain in the middle part of the heel bone. Especially after getting up in the morning or after longer breaks, the pain occurs more intensely. During a rest, plantar flexion occurs in the foot. This causes the plantar fascia to shorten a little. When the patient rolls his foot again while walking, the aponeurosis plantaris stretches again. This process in turn causes pain. Normally, the pain decreases again a short time later. However, it can increase again if the foot is subjected to prolonged stress. Plantar fasciitis is unilateral in 70 percent of all patients. In the remaining 30 percent, however, it occurs on both sides. In around 80 percent of all sufferers, there is also tension in the Achilles tendon. In addition, most patients have difficulty bending their foot. If plantar fasciitis persists over a longer period of time, there is a risk of heel spur formation. This is a small bone outgrowth that occurs on the heel bone and points in the direction of the toes.
Diagnosis and course of the disease
Plantar fasciitis is usually diagnosed already by its typical symptoms. These include tenderness of the sole of the foot and heel pain in the morning. Further examination measures usually take place only if conservative therapy is unsuccessful or injections are to be performed. X-rays can often detect a heel spur as well. The same applies to fatigue fractures or tumors, which can also be a reason for heel pain. Another diagnostic method is sonography (ultrasound examination). It can be used to detect thickening of the plantar fascia. Alternatively, examinations such as a skeletal scintigraphy or magnetic resonance imaging (MRI) can also be considered. The course of plantar fasciitis is generally positive. The foot condition usually improves again after one year. It does not matter which therapy is used.
Complications
Untreated plantar fasciitis can become chronic and be associated with permanent severe pain. Conservative therapy of the disorder is usually very lengthy and takes several months, but complications are generally not to be expected.In about one in twenty sufferers, conservative therapies do not lead to the desired success – these include, in particular, shoe inserts and physiotherapy as well as non-steroidal anti-inflammatory drugs to combat the pain. In this case, surgery may be appropriate, even though it is not a common treatment method. Surgery is associated with a number of risks. For example, it is possible that the pain after the surgical intervention is stronger than before and spreads to the midfoot. This is a particular concern if the entire plantar fascia was cut during surgery. If the surgeon injures the tendon plate, a flat foot may develop. In addition, there are a number of nerves in the foot that can be affected by surgery. This can lead to chronic pain that is worse than that of the initial condition. Loss of mobility of one or more toes is also not impossible. In addition, as with any surgery, general surgical risks can occur. For example, the wound can become infected and, in the worst case, lead to sepsis. In addition, painful or unsightly scars may remain. Venous thrombosis as a result of the surgery is another possible complication.
When should you go to the doctor?
Since plantar fasciitis does not heal itself, this condition must always be examined and treated by a doctor. Only early diagnosis and treatment can prevent further complications. As a rule, the life expectancy of the affected person is not negatively affected by plantar fasciitis. The doctor should be consulted for plantar fasciitis if the affected person suffers from severe pain in the feet. The pain can also spread to the entire leg and have a very negative impact on the affected person’s daily life. The Achilles tendon is also negatively affected by the condition and can tear. Therefore, if the pain in the feet occurs over a long period of time and does not disappear again on its own, a doctor must be consulted in any case. As a rule, plantar fasciitis is treated by an orthopedist or by a sports physician. Whether this will result in a complete cure cannot generally be predicted.
Treatment and therapy
Several options are available to treat plantar fasciitis. Physical treatment is considered particularly effective. It includes stretching exercises for the plantar fascia and the Achilles tendon. Through these measures, an improvement in the symptoms can be achieved after two months. LowDye taping is also part of physical therapy. This involves applying a tape bandage around the foot to support the longitudinal arch. This results in a reduction of pressure on the aponeurosis plantaris during running movements. To relax the muscle fascia and improve circulation, special foot massages can also be given. Helpful against plantar fasciitis is also the use of orthoses. In this method, the patient receives orthopedic insoles for his shoes. The orthoses counteract overpronation of the foot. At night, the patient can also wear leg splints. These prevent a plantar-fixed foot position. To combat the pain, painkillers such as nonsteroidal anti-inflammatory drugs are also administered. If conservative therapy shows no success, corticosteroids can be injected into the diseased foot. This method is successful after a short time. However, there is a risk of fat pad shrinkage in the heel. This in turn increases the risk of plantar fasciitis. Another treatment option is extracorporeal shock wave therapy. Its aim is to stimulate the body to produce a positive inflammation. Surgery is required in only one percent of all patients after conservative treatment has failed.
Prevention
Running athletes can prevent plantar fasciitis by making sure their training is balanced and regular. Stretching and strengthening exercises are also considered helpful. It is also important to avoid severe obesity and prolonged standing.
Aftercare
In most cases of plantar fasciitis, patients have very few, if any, special measures of aftercare available to them.First and foremost, a doctor should be consulted in the case of this disease, so that an early diagnosis can be made and rapid treatment can be initiated. Therefore, the sooner a doctor is consulted, the better is usually the further course of the disease. Self-healing cannot occur with plantar fasciitis. Most sufferers are dependent on taking various medications. Regular intake and also correct dosage must always be observed. In case of uncertainty or questions, a doctor should always be consulted first. A doctor should also be contacted in case of side effects. In many cases, affected persons should wear a bandage on the foot to relieve the foot and prevent further discomfort. Foot massages can also be very helpful and significantly alleviate the symptoms. Some sufferers rely on their own family for care in their daily lives, and psychological support can also be very helpful in many cases. As a rule, plantar fasciitis does not reduce the life expectancy of the affected person.
What you can do yourself
In the case of plantar fasciitis, some self-help measures are possible, which can facilitate the everyday life of the affected person and likewise accelerate the healing of the disease. In the case of overweight, this must be reduced, since the excess weight promotes plantar fasciitis. The affected person should pay attention to a healthy diet. Sports activities should be done in such a way that they do not put excessive stress on the feet and legs. In general, the lower extremities should no longer be subjected to excessive stress. In some cases, inserts can be worn in the shoes to relieve discomfort. Furthermore, plantar fasciitis is often treated with the help of medication and by painkillers. Here, care must be taken to ensure that they are taken regularly and that they may interact with other medications. Movement can be increased again with the help of physiotherapeutic exercises, and these exercises can also be performed in the patient’s own home. It is recommended that the extremities be stretched and extended, and strength exercises may also be helpful. The patient should avoid standing for long periods of time when suffering from plantar fasciitis. Furthermore, regular checkups with a physician are advisable.
