Plantar fasciitis is an inflammation (swelling, pain and redness) of the plantar fascia, that is, the connective tissue or ligament present on the sole of the foot, connecting the heel to the toes.
It is the commonest cause of pain in the heel, making walking or even mere standing very difficult. It is common in middle-aged persons especially in those who are overweight, though younger people subjecting their feet to stress, like soldiers or sportsmen, are also susceptible. Both feet can be affected. It occurs roughly in 10% of the population across a lifetime.
Plantar Fasciitis Causes
Plantar fasciitis is caused due to strain of the ligament supporting the arch of the foot. This can happen due to improper walking such as rolling the feet inward, overuse of feet, wearing of ill-fitting shoes, or you are overweight, have flat feet or high arches, have tight calf muscles or Achilles tendon.
Plantar Fasciitis Symptoms
The main symptom is pain in the heel and foot especially when taking the first steps after resting a while. The pain and stiffness usually lessens after walking a bit. But towards the end of the day or upon climbing stairs or standing for protracted period, the foot may again begin to hurt.
Diagnosis depends on history and careful clinical examination of the patient while standing or walking. Stress fracture needs to be ruled out by an X-ray. Ultrasound and even MRI have a role.
Treatment and Cure for Plantar Fasciitis
Treatment has to be individualised. Giving rest to the feet, and avoiding painful activities such as walking or running on hard surface will give some relief. Local massage, application of ice on the heel reduces some of the swelling and pain.
Over-the-counter analgesics like aspirin or ibuprofen can provide considerable relief from pain. Change shoes if they are not comfortable for you. Orthotics like shoe inserts or heel cups can be used. Stretching of calf muscles can help. Weight should be reduced if you are overweight.
If the problem still persists, you may need to use splints at night or get steroid injections. Long-term treatment with steroids is not advisable because of the risk of rupture of plantar fascia. It may take a few weeks for the problem to decrease in intensity, and may take months or even a year for the pain to completely go away. If not, you may need to go for surgery.
Surgery is not always successful and moreover carries complications like injury to a nerve, infection, and plantar fascia rupture. Needle fasciotomy guided by ultrasound is a minimally invasive surgery in which a needle is moved back and forth in the plantar fascia to break up the fibrous tissue.
Coblation surgery, also known as Topaz procedure, is indicated in plantar fasciitis resistant to treatment. It is a minimally invasive technique utilizing radiofrequency ablation. Traditional procedures like release of plantar fascia are measures of last resort because of their complications like arch lowering and pain in superolateral surface of the foot.
Extracorporeal shock wave therapy (ESWT) is not of definite proven benefit. In some cases, it is tried before surgery as the risk from it is minimal.