Plantar Fasciitis: Symptoms, Risk Factors, Causes, Healing Cycle & Treatment
What is Plantar Fasciitis?
The plantar fascia is a thickened layer of deep fascia that runs from the heel to the toes on the underside of the foot. It helps in weight distribution along the foot and acts as a support to maintain the arches of the sole, in particular, the medial arch. (1) It acts like a shock-absorbing bowstring.
Stretch of the plantar fascia can result in micro-injuries and tears, particularly on the medial side. These small tears result in inflammation and the development of scar tissues. As a result of these degenerative changes, pain is induced in the heel and along the undersurface of the foot. (2)
Plantar fasciitis is one of the most common causes of pain in the foot and heel. It is relatively more common in athletes and people with a sedentary lifestyle.
What Are The Symptoms of Plantar Fasciitis?
Plantar fasciitis commonly causes the following symptoms: (3)
● Pain on the bottom of the heel that feels like stabbing, particularly while taking the first few steps in the morning.
● Pain improves with movement.
● Prolonged standing or resting in the same position may induce the pain again.
● Swelling of the heel.
● Increased pain on sitting after prolonged exercise.
What Are The Risk Factors?
Risk factors for developing plantar fasciitis include:
● Excessive stretching of the foot that results in micro-tears of the fascia and resultant inflammation.
● Repetitive impacts such as running, jumping, dancing, etc., and other athletic activities. This is particularly common if exercise and running etc. is done without proper footwear.
● Arch of the foot is lower (flat-foot) or higher than normal.
● Unusual gait pattern.
● Increased dorsiflexion of feet at ankle joint.
● Obesity, especially BMI of greater than 30 kg/m. (4)
● Increased weight bearing on feet, especially prolonged standing.
● Tightness in the muscles of the calf. This occurs in particular when exercise is done without prior stretching of the muscles. (5)
How To Treat Plantar Fasciitis?
To understand how to properly and correctly treat plantar fasciitis, we need to understand the pathophysiology of the processes involved in the development of this condition.
Pathogenesis of Plantar Fasciitis – Healing Cycle:
The response of our body to any form of injury is more or less the same. It involves the following stages: (6)
1. Inflammation: This is the first process involved in the process of healing. After an injury occurs, blood rushes to the site of injury and immune cells are recruited. This induces pain and swelling in the region, As a result of this, the affected region suffers from decreased functionality. (7)
2. Proliferation: In this stage of wound healing, the cells produce collagen and fibrin. This causes a build-up of scar tissue due to fibrosis. Scar tissue acts as a glue to keep the site of injury together. Additionally, fascia restrictions, muscle spasms, and trigger points also develop during this stage. (8)
3. Maturation: This is the final stage of wound healing in which the scar tissue is remodeled. The body gets rid of excessive scar tissue, muscle spasms as well as trigger points. (9)
If the body does not complete the process of healing, the site of injury goes back and forth between the processes of inflammation and proliferation. This results in the development of excessive scar tissue and adhesions between the various layers of fascia. As a result of this, tightness and restriction of movement develop. For this reason, for proper and long-term treatment of plantar fasciitis, we need to target and control both inflammation and proliferation.
What Doesn’t Help?
There exist many common treatment modalities that do not help. Some of these include:
● Heat and Ice: Heating pads and ice may temporarily help in pain relief but they do not do anything to help fix the underlying problem. Ice may, in fact, actually increase the degree of inflammation at the site of tissue injury.
● ESTIM is a physiotherapeutic tool for the electrical stimulatory treatment of functional impairment of muscle. This also offers temporary alleviation of pain but does not aid in healing. (10).
● Foam Rollers and Massage: These are used to massage or rub against the tissue. This may increase inflammation by causing friction between the layers of the fascia.
● Stretching and Exercise: Stretching an inflamed tissue increases the stress on it and causes it to become more inflamed. Strength gaining exercises are important but they should only be done once the tissue is out of the inflammatory phase.
What Does Help?
If you have acute plantar fasciitis, it will likely heal by itself in 2-3 days. To aid the healing process, you need to rest well.
For chronic or repetitive episodes of plantar fasciitis, the following treatment modalities will help ease inflammation:
● Rest well.
● MagnaHeal: This tool makes use of the targetted magnetic field on the area of tissue injury. With a magnetic field of almost 3 inches in depth, this penetrates at the tissue level and decreases inflammation.
● An anti-inflammatory diet is an important component to aid the process of healing. Foods high in refined sugars and carbohydrates may increase inflammation.
● Nutritional Supplementation: If your body is deficient in essential minerals and vitamins, it cannot heal properly. (11) To help you with this, the askASTR website has a database of 9 healthcare providers. By answering a simple and free online questionnaire, you can find out which nutrients your body and diet are lacking and how to address their deficiency.
To target the proliferation stage of healing, the following are useful:
● Release of scar tissue and trigger points: The A3 tool acts to break scar tissue and adhesions that are present superficially. The A5 tool targets deeper layers of scar tissue.
● Fascia Release: The A1 and A5 tools are used to break superficial and deep fascia restrictions, respectively.
● Normalize gait pattern.
● Wear proper footwear and avoid high heels.
● Correct pronated foot.
Now that you understand what’s causing the pain in your heel and how it works, you can get around to treating it.
1. Lim AT, How CH, Tan B. Management of plantar fasciitis in the outpatient setting. Singapore Med J. 2016 Apr;57(4):168.
2. Plantar Fasciitis [Internet]. [cited 2021 Sep 24]. Available from: https://www.physio-pedia.com/Plantar_Fasciitis
3. Plantar Fasciitis [Internet]. [cited 2021 Sep 24]. Available from: https://my.clevelandclinic.org/health/diseases/14709-plantar-fasciitis
4. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am [Internet]. 2003 May [cited 2021 Sep 24];85(5). Available from: https://pubmed.ncbi.nlm.nih.gov/12728038/
5. Hamstra-Wright KL, Kc HB, Bay RC, Aydemir B. Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis. Sports Health [Internet]. 2021 [cited 2021 Sep 24];13(3). Available from: https://pubmed.ncbi.nlm.nih.gov/33530860/
6. Wallace HA, Basehore BM, Zito PM. Wound Healing Phases. In: StatPearls [Internet]. StatPearls Publishing; 2021.
7. Michael H. Askenase LHS. Stages of the Inflammatory Response in Pathology and Tissue Repair after Intracerebral Hemorrhage. Semin Neurol. 2016 Jun;36(3):288.
8. Landén NX, Li D, Ståhle M. Transition from inflammation to proliferation: a critical step during wound healing. Cell Mol Life Sci. 2016;73(20):3861.
9. Meilang Xue CJJ. Extracellular Matrix Reorganization During Wound Healing and Its Impact on Abnormal Scarring. Adv Wound Care. 2015 Mar 1;4(3):119.
10. Dehail P, Duclos C, Barat M. Electrical stimulation and muscle strengthening. Ann Readapt Med Phys [Internet]. 2008 Jul [cited 2021 Sep 24];51(6). Available from: https://pubmed.ncbi.nlm.nih.gov/18602713/
11. Stechmiller JK. Understanding the role of nutrition and wound healing. Nutr Clin Pract [Internet]. 2010 Feb [cited 2021 Sep 24];25(1). Available from: https://pubmed.ncbi.nlm.nih.gov/20130158/
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