In team sports, there are often unsung heroes who greatly influence the outcome of the game: offensive linemen in football, midfielders in soccer, catchers in baseball, and many other examples. If you’re a casual fan, you may hardly notice their presence unless something goes wrong with their performance.

The plantar fascia on the bottom of your foot is an unsung hero.

This unassuming sheath of tissue is critically important for walking and weight-bearing. When this structure gets inflamed, it is termed plantar fasciitis, causing heel and foot pain that can be chronic and quite bothersome. Here’s what you need to know about plantar fasciitis, its diagnosis, and its treatment.

 

What is plantar fasciitis?

Under the bones of your feet, near the heel, is a fan-like spread of fibers that are collectively called plantar fascia. These fibers attach at your heel and spread along the soles of your feet, out toward the foot bones just below your toes. The plantar fascia acts in a similar way to bungee cords under tension or the springs at the end trampoline when someone is jumping on it. This function allows the foot to bear weight and stresses, especially when you initiate your step.

Accordingly, the plantar fascia is essential for walking, running, changing direction, jumping, landing and stopping. Improper function of the plantar fascia results in plantar fasciitis. About 10% of people get plantar fasciitis, and it’s more common as you age.

The suffix “-itis” in medicine refers to inflammation since the condition was thought to be due to inflammation. However, recent evidence shows that plantar fasciitis is less a result of inflammation than it is of biomechanics.

What causes plantar fasciitis?

Since inflammation doesn’t cause plantar fasciitis, what does? Though it isn’t well understood yet, it is believed that microtrauma (small tears) in the plantar fascia cause changes like calcium deposits and disorganization in the arrangement of the plantar fascia fibers. That, in turn, reduces how much tension the plantar fascia can bear.

In the picture, you can see the most common areas of pain and sensitivity in plantar fasciitis cases.

 

What do I look out for? 

The most common symptoms of plantar fasciitis are heel pain and pain along the sole of the foot.

A typical pattern for plantar fasciitis is that the pain is worse during the morning or after prolonged rest, and can be reproduced or increased by flexing the toes towards the shin. It is usually one-sided, and can also be made worse with weight-bearing.

 

What are the risk factors for plantar fasciitis?

Though researchers aren’t clear on why plantar fasciitis occurs, they have established the risk factors for it. You are more likely to get plantar fasciitis if you:

• Are a “weekend warrior” (i.e., mostly sedentary, with occasional dramatic increases in exercise)
• Have high arches
• Have flat feet
• Are obese
• Run avidly
• Are an elite athlete
• Have different leg lengths

Plantar fasciitis is primarily a mechanical problem of arch support; all of the above conditions result in increased tension on the plantar fascia.

 

How does plantar fasciitis get evaluated?

Plantar fasciitis is often diagnosed by health care providers after patients present with heel pain since this condition is responsible for about 80% of heel pain complaints. Often, a person’s clinical history includes a history of explosive or prolonged exercise or a history of an abrupt increase in exercise.

A clinical examination might reveal reproducible tenderness near the heel or pain when the toes are flexed towards the shin. Diagnostic imaging studies like X-rays or ultrasounds usually aren’t necessary. Plantar fasciitis is often self-diagnosed, especially in those who experience chronic symptoms.

 

How does plantar fasciitis get treated?

Similar to other connective tissue conditions like tendinitis, plantar fasciitis tends to get better gradually with conservative treatments. Insoles that support the arches and reduce or redistribute the weight-bearing responsibilities of the plantar fascia can be helpful.

Regular foot massages administered by self, a partner or a massage therapist are also first-line therapies. Non-steroidal anti-inflammatory medications like ibuprofen are likely to help, though data on its usage is not conclusive.

The RICE method —  Rest, Ice, Compression and Elevation — is an effective treatment for plantar fasciitis. With conservative measures like these over 90% of cases show improvement within six months.

In rare instances, when plantar fasciitis does not respond to these measures, more aggressive steps can be taken. Steroid injections, night splints, shockwave therapy, and surgery are among the treatments for plantar fasciitis considered when conservative treatment is ineffective.

 

Can I prevent plantar fasciitis?

Prevention plans for plantar fasciitis depend on your risk factors. Those who are obese or have sedentary lifestyles can gradually increase the amount of exercise they get per week to reduce risk.

For those who already engage in vigorous exercise, the object is to decrease the stress loads and impact (force overtime) to which the plantar fascia is subjected. That can be accomplished by:

• Running on soft surfaces
• Keeping exercise increases gradual
• Using orthopedic inserts
• Using shoes with arch support

By getting to know the causes and treatments of plantar fasciitis, as well as how to prevent its recurrence, you can get back on your feet in no time.

 

References:

• Bolgla, L. A., & Malone, T. R. (2004). Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. Journal of Athletic Training, 39(1), 77–82.
• Cutts, S., Obi, N., Pasapula, C., & Chan, W. (2012). Plantar fasciitis. Annals of the Royal College of Surgeons of England, 94(8), 539–542.
• Zhang, J., Nie, D., Rocha, J. L., Hogan, M. V., & Wang, J. H. (2018). Characterization of the structure, cells, and cellular mechanobiological response of human plantar fascia. Journal of Tissue Engineering, 9, 2041731418801103.
• Trojian, T. and Tucker, A. K. (2019). Plantar Fasciitis. American Family Physician, 99(12):744-750.
• Yin M.-C., Ye J., Yao M. et al. (2014). Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Archives of Physical Medicine and Rehabilitation,  95  (8) , pp. 1585-1593.
• Lim, A. T., How, C. H., & Tan, B. (2016). Management of plantar fasciitis in the outpatient setting. Singapore Medical Journal, 57(4), 168–171.