Plantar fasciitis (plantar fasciosis) is a disease caused by bony overgrowth and inflammatory and degenerative changes in the plantar fascia, the ligamentous tissue that extends from the heel to the base of the toes on the sole of the foot. The pathology is characterized by painful manifestations in the area of attachment of the plantar ligament to the heel bone (calcaneal spur, enthesopathy), with possible irradiation of pain along the medial zone of the plantar fascia.

Types of Plantar Fasciitis

There are three main types of plantar fasciitis

  1. Proximal: pain is localized in the heel area, closer to the shin. It may extend to the inner side of the ankle. Often associated with degenerative changes in the toe flexor tendon.
  2. Medial: soreness is felt over the entire plantar surface of the foot, but is most pronounced in the area under the big toe. Associated with inflammation or micro tears of the plantar fascia in this area.
  3. Lateral: localization of pain is noted on the outside of the foot, under the base of the fifth metatarsal bone, with possible irradiation to the back of the foot. It is often associated with excessive pronation (cushioning) of the foot.

The clinical picture of plantar fasciitis may be acute or chronic.

  1. Acute form: develops suddenly or within a few days, manifested by a stabbing or pain in the heel when walking. The pain is dull or sharp, sometimes burning. It intensifies in the morning after sleep and diminishes during the day. There is stiffness, moderate swelling of the foot, and pain in its arch and Achilles’ tendon area.
  2. Chronic form: develops gradually and can last for several weeks, months or even years. It is characterized by aching or dull pain in the heel area, which may increase during the day or after physical activity.

Compared to the acute form, the stiffness of the foot is less pronounced. The pain is localized in the area of attachment of the plantar fascia to the heel bone, but can extend to the entire sole of the foot. Painful heel pressure may be noted.

In addition to these two main forms, there are other, less common variants of plantar fasciitis.

  • Heel bursitis: inflammation of the mucous membrane under the heel tubercle.
  • Heel nerve tunnel syndrome: pinched nerve in the heel area.
  • Stress fracture of the heel bone: microscopic fractures of the bone caused by repetitive stress.

These clinical forms of the disease are not always clearly delineated. One person may present symptoms characteristic of different forms.

For an accurate diagnosis and prescription of the correct treatment of plantar fasciitis, it is necessary to consult a doctor.

Causes of Plantar Fasciitis

Many factors contribute to the cause of plantar fasciitis.

  1. Mechanical factors
  • Plantar aponeurosis: overload, microtrauma, shortening or contracture.
  • Feet: flat feet, high or low arch, deformities.
  • Shoes: uncomfortable, high heels, poor cushioning.
  • Stress: running, jumping, standing or walking for long periods of time.
  1. Anatomical factors
  • Flat feet: longitudinal, transverse, combined.
  • Foot deformities: ossicles, hallux valgus, heel spurs.
  • Features of foot structure: high or low arch, flattening of the anterior metatarsal arch.
  1. Systemic factors
  • Overweight: increased stress on the feet.
  • Age-related changes: degeneration of connective tissue.
  • Pregnancy: weight gain, hormonal changes.
  • Diseases: arthritis, rheumatoid arthritis, psoriatic arthritis, gout, and diabetes mellitus.
  • Associated diseases: spinal diseases, endocrine disorders, and metabolic disorders.
  1. Other factors
  • A sudden increase in physical activity.
  • Poor stretching of calf muscles and Achilles’ tendon.
  • Muscle weakness and foot injuries.

Poor working conditions: prolonged standing, vibrations.

Symptoms and Signs

The disease can be recognized by characteristic signs and symptoms, the main of which is pain:

  • sharp or dull pain in or along the heel, often intensified by stress on the foot, especially after prolonged rest or sleep;
  • morning sharp, burning pain on first steps after waking up;
  • increased pain with prolonged walking or standing, especially on hard surfaces.
  • pain when climbing stairs - due to the additional load on the feet and heels.

In some cases, the disease may be accompanied by:

  • painful sensitivity and swelling in the heel area;
  • thickening or inflammation in the heel area;
  • limited mobility of the foot, especially in the morning;
  • difficulty standing on tiptoe or walking on the heel;
  • clicking in the heel when walking.

The symptoms of plantar fasciitis and their severity can vary from person to person, so not all patients will experience all of the above symptoms in the same way. If these signs are present, it is important to see a doctor for an accurate diagnosis.

Diagnostics: Understanding the Condition

Diagnosis of plantar fasciitis is based on:

  • History-taking: identifying symptoms, medical history and risk factors.
  • Physical examination: examining the feet and performing a mobility and sensitivity test.
  • Radiographs: to rule out fractures or other podiatric conditions.
  • Magnetic resonance imaging (MRI): to examine the soft tissues of the foot in more detail.

Based on the results of the examination, the doctor selects the most likely treatment tactics in each case.

Treatment Options for Plantar Fasciitis

Modern methods of treatment for this pathology include both conservative approaches and surgical interventions.

Conservative treatment

  1. Rest and limitation of activity: avoid prolonged periods of standing or walking on hard surfaces.
  2. Physical therapy: stretching and strengthening exercises for the muscles of the foot and lower leg, massage techniques or tissue treatments to soothe and reduce inflammation.
  3. Use of orthotic inserts or supportive shoes.
  4. Use of support devices: plantar heels or night splints to keep the foot in the correct position.

Drug therapy

  1. Anti-inflammatory and analgesic drugs: NSAIDs or creams for external application.
  2. Injections of a cocktail of drugs: steroids or botulinum toxin preparations.

In cases where conservative methods do not bring proper relief, surgical intervention may be considered. Each of them fulfills certain purposes: elimination of excessive fascia tension, adhesions, microscopic tears, destruction of fascia tissue, which promotes tissue healing, reduction of inflammation, pain sensitivity and rapid recovery.

According to the problems identified, patients may be offered

  1. Stonebrock's procedure.
  2. Endoscopic fasciectomy.
  3. Plantar fascia release.
  4. Extracorporeal shockwave therapy.
  5. Radiofrequency ablation.
  6. Ultrasound therapy and laser treatment.

The decision of whether minimally invasive surgery is right for you should be made by you and your doctor after a thorough discussion of all options.

Regardless of which treatment method you choose, it is important to follow your doctor's recovery instructions to ensure a full recovery.

Looking for the best doctor to treat plantar fasciitis? Illinois Foot & Ankle Clinic can be the right choice for you!

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