Plantar Fasciitis

The plantar fascia is a thick ligament of strong connective tissue which maintains and stabilizes the arch of the foot. Connecting from your heel bone to your metatarsal or ball of your foot, it helps support your body weight as you walk, run or exercise.

Immense stress is placed on the plantar fascia which often leads to degeneration of the ligament, the formation of calcium deposits and inflammation known as plantar fasciitis.

The average person takes 1900 steps per day or walks approximately 1 mile. Each time you take a step tiny microfibers are shaved off of your fascia ligament, weakening its structural integrity, causing degeneration of the tissue. The pain you experience comes in part from this degeneration and from the pulling or tugging motion of the ligament where it connects to the heel bone. The inflammation of the plantar fascia is interpreted by your brain as a burning, shooting and even stabbing pain in the heel or arch of the foot which is often debilitating.

Plantar fasciitis is considered the most common form of foot pain with approximately 3,000,000 new cases each year in the United States. Approximately 10% will suffer from plantar fasciitis at some point during their lifetime and 70% of those that incur this disorder suffer unilaterally or on one foot. Fasciitis is common among athletes, runners, dancers, people who are on their feet a lot, soldiers and people between the ages of 40 to 60. The incidence of occurrence effects both men and women equally.

Individuals that have one or more of the following conditions are at higher risk and may even suffer from repeated bouts of plantar fasciitis; people with pronating or pigeoning feet (feet rolling inward when walking), high arches or flat feet, people who are overweight, women who are pregnant and those wearing shoes with inadequate support. A recent change in footwear, shoes that do not fit correctly or are heavily worn can also increase the risk of injuring the plantar fascia.

Those suffering from plantar fasciitis often describe a sharp pain when taking their first steps after getting out of bed or after sitting or being motionless for long periods of time. This occurs because when the plantar fascia is at rest, like during sleep, it resides in the shape of a U. Once you put your foot on the ground it flattens out, taking an I shape. As you walk the pulling begins, increasing the pain, as the fascia ligament remains in an I-formation during movement. Jumping can be particularly stressful on the ligament as the plantar fascia is switching back and forth from a U to I-formation rapidly. Blood flow will often help decrease the pain, but in order to stop plantar fasciitis completely you must keep the fascia ligament fixed so it does not pull against the heel bone. Once you control the ligament during movement so it remains fixed your inflammation will begin to subside and so will your pain.

Approximately 90% of all plantar fasciitis cases are acute, meaning that they will resolve within 30 to 180 days and will not require invasive surgery to repair tears in the ligament. Plantar fasciitis accounts for 80% of all heel pain cases and approximately 59 million people suffer from heel pain annually. Rest, stretching and cold therapy can help relieve inflammation and pain.

NSAID’s like Ibuprofen help relieve inflammation and are commonly used when treating plantar fasciitis, but can be dangerous with prolonged daily use, damaging the kidneys and liver. Approximately 20% of the people that use NSAID’s fail to resolve pain.

Cortisone shots is also a recommended treatment, but offers little results. Cortisone is a steroid that weakens the fascia ligament and although it can provide mild, short-term, relief, up to 30 days, it is extremely painful and dangerous and results are not guaranteed. Studies have shown that Cortisone is not an effective mechanism for permanent and sustainable pain relief from plantar fasciitis. You may receive up to 2 Cortisone shots in the same location as over time Cortisone will degrade tissue and increase cellular degeneration of the plantar fascia.

Insoles and orthotics, both over-the-counter and custom-made, have the same 1 in 10 resolution rate per the American Podiatric Medical Association (APMA). They are a good remedy for sore or tired feet for those who require more cushioning, but cannot control the plantar fascia. The idea behind an insole or even prescription orthotic is to cut the distance between the top of your shoe and the bottom of your foot, thus sandwiching your fascia ligament in an attempt to stop it from moving, unfortunately this is not a proven and effective solution.

Non-invasive medial appliances offer the greatest resolution rates with the least risk and can often accelerate the healing process dramatically. Topical pain relievers with all natural herbal compounds applied directly to the treatment area can also relieve pain and inflammation. 

The key to a speedy recovery, however, is to identify how the disorder occurred, alter your routine, rest the injured foot or feet, apply cold therapy to help relieve the immediate pain and when necessary use a medical appliance that can stop the plantar fascia from moving as you do.

Chronic conditions will require more aggressive treatment and both X-rays and an MRI is recommended. Both surgery and radial shockwave therapy have shown to have similar efficacy ratings assuming the diameter of the fascia ligament does not exceed 7mm to 8mm. An MRI will determine how thick your fascia ligament is so you can determine the appropriate next steps with your practitioner.

Ignoring plantar fasciitis could lead to heel spurs and may even result in chronic heel pain that will hinder your daily activity. Attempts to minimize plantar fasciitis pain by altering your gait or the way you walk can lead to added foot pain, bilateral plantar fasciitis, knee pain and hip and back problems.