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Plantar fasciitis (heel spur syndrome)

 
Plantar fasciitis is the most common cause of heel pain.  It can be caused by inadequate or inappropriate footwear, weight gain, or a particular exercise or activity. It is common for plantar fasciitis symptoms to affect only one foot at a time. Treatment focuses on reducing pain and inflammation.
 
Chronic (long-term) plantar fasciitis can lead to a build-up of bone (a "spur") at the point where the plantar fascia connects to the heel bone. For this reason, plantar fasciitis is sometimes referred to as "heel spur syndrome". 

Signs and symptoms

Plantar fasciitis is the inflammation of the plantar fascia - a band of tough fibrous tissue running along the sole of the foot. It occurs when small tears develop in the plantar fascia, leading to inflammation and heel pain.
 
The plantar fascia tissue branches out from the heel like a fan, connecting the heel bone to the base of the toes. When the foot moves, the plantar fascia stretches and contracts. The plantar fascia helps to maintain the arch of the foot in much the same way that the string of a bow maintains the bow's arch.
 
Plantar Fascia
 
 Plantar Fasciitis 1
Diagram courtesy of Wellington Chiropractic
 
The most notable symptom of plantar fasciitis is heel pain. This is typically most severe in the middle of the heel though it may radiate along the sole of the foot. The pain is most often felt when walking first thing in the morning or after a period of rest. As walking continues the pain may decrease; however, some degree of pain remains present on movement. The pain may disappear when resting, as the plantar fascia is relaxed.   Redness, swelling and warmth over the affected area may also be noticed.
 
The onset of plantar fasciitis is gradual and only mild pain may be experienced initially. However, as the condition progresses the pain experienced tends to become more severe. Chronic plantar fasciitis may cause a person to change their walking or running action, leading to symptoms of discomfort in the knee, hip and back.  

Causes

When the foot moves, the plantar fascia stretches and contracts. Plantar fasciitis is caused by the repetitive overstretching of the plantar fascia. If the tension on the plantar fascia is too great, this overstretching causes small tears in the plantar fascia. This in turn causes the plantar fascia to become inflamed and painful.
 

Factors that contribute to the development of plantar fasciitis include:  

  • Having very high arches or flat feet
  • Gender - while anyone can develop plantar fasciitis, it tends to occur more commonly in women
  • Exercises such as running, walking and dancing - particularly if the calf muscles are tight
  • Activities or occupations that involve walking or standing for long periods of time - particularly on hard surfaces
  • Wearing high-heeled shoes and/or shoes that do not offer adequate arch support and cushioning
  • Being overweight - additional weight increases the tension on the plantar fascia
  • Poor biomechanics - extra tension is placed on the plantar fascia if weight is not spread evenly when standing, walking or running
  • Rapid change in activity level
  • Tightness in the hamstring muscles, calf muscles and the Achilles tendon.

Some cases of plantar fasciitis may be linked to underlying diseases that cause arthritis, such as ankylosing spondylitis

Diagnosis

Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays or magnetic resonance imaging (MRI) may be recommended to rule out other causes for the symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.

Treatment

The initial treatment of plantar fasciitis focuses on reducing pain and inflammation. Resting the affected foot is the most important aspect of this treatment.  Other initial treatment may include: 

  • Applying ice to the sole of the foot
  • Anti-inflammatory medications
  • Gentle stretching of the plantar fascia and Achilles tendon
  • Physiotherapy
  • Taping the foot and ankle to provide adequate support and alignment
  • Wearing supportive footwear with shock-absorbing soles or inserts.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac are often used to treat plantar fasciitis.  It is unclear whether NSAIDs assist in the healing process but they are useful for reducing inflammation and pain during treatment.
 
If the condition does not respond to initial treatment, a corticosteroid therapy may be recommended. This involves the injection of corticosteroid medication such as hydrocortisone into the affected area in order to directly treat the inflammation and thus relieve the pain. Night splints to prevent the plantar fascia tightening during sleep may also be recommended at this stage.
 
Surgery is rarely used in the treatment of plantar fasciitis. It is generally only used where the pain is severe and all other treatments have failed. Surgery usually involves the partial or full release of the plantar fascia from the heel bone.  This type of surgery, known as asciotomy, has a 70-90% success rate 

Prevention  

Factors that help prevent plantar fasciitis and reduce the risk of recurrence include: 

  • Exercises to strengthen the muscles of the lower leg and ankle
  • Stretching to increase the flexibility of the Achilles tendon and calf muscles
  • Warming up before commencing physical activity
  • Increase exercise/activity levels gradually
  • Maintaining a healthy body weight
  • Wear supportive shoes
  • Avoiding high heeled footwear
  • Using orthotic devices such as arch supports and heel raises in footwear - particularly for people with very high arches or flat feet.
  • Daily stretches of plantar fascia and Achilles tendons. 

References

Mayo Clinic (2017). Plantar fasciitis (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/home/ovc-20268392 [Accessed: 16/08/17]
MedlinePlus (2016). Plantar fasciitis (Web Page). Bethesda, MD: US National Library of Medicine (NIH). https://medlineplus.gov/ency/article/007021.htm [Accessed: 16/08/17]
Young, C.C. (2016). Plantar fasciitis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/86143-overview [Accessed: 16/08/17]
 
 
Last reviewed -  August 2017
 
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