Introduction
Welcome to the Oswald Gibson Cape Orthotics and Prosthetics blog, where we explore the intricacies of foot health and mobility. Today, we delve into probably one of the most common yet often misunderstood foot conditions: plantar fasciitis. As a leading orthotist and prosthetist based in Cape Town, I bring a wealth of knowledge and experience in addressing various foot ailments, including plantar fasciitis.
This condition, characterised by pain in the heel and bottom of the foot, affects numerous individuals, impacting their daily activities and quality of life. Through this article, we aim to shed light on plantar fasciitis, unraveling its causes, symptoms, and the variety of treatments available. Our goal is not just to inform but to guide you towards effective solutions for relief and recovery.
Section 1: What is Plantar Fasciitis?
The Basics of Plantar Fasciitis
Plantar fasciitis is a condition resulting from inflammation of the plantar fascia, the thick band of connective tissue that runs across the bottom of your foot, from the front of the heel bone to the ball of the foot. This dense strip of tissue helps support the longitudinal arch of the foot.
This ailment is often associated with a stabbing pain that typically occurs with your first steps in the morning. As you move more, the pain usually decreases, but it might return after long periods of standing or when you stand up after sitting for lengthy periods.
Incidence and Prevalence
In South Africa, like in many parts of the world, plantar fasciitis is a common complaint among adults, especially those between the ages of 40 and 60. It’s prevalent in both athletes and non-athletes, affecting individuals who spend a significant amount of time on their feet. At Oswald Gibson Cape Orthotics and Prosthetics, we frequently encounter clients seeking relief from this persistent foot pain. Individuals with tight calves and achilles tendons are prone to plantar fasciitis. This is also more common in a foot that pronates vs a supinating foot.
Understanding the mechanism of the Plantar Fascia
The plantar fascia is a bowstring-like ligament that supports the arch of your foot and absorbs shock as you walk. But tension and stress on this bowstring can cause tiny tears in the fascia. Repetitive stretching and tearing can irritate or inflame the fascia, though the exact cause remains unclear in some cases.
Section 2: Symptoms of Plantar Fasciitis
Identifying Plantar Fasciitis
The hallmark symptom of plantar fasciitis is a sharp, stabbing pain at the bottom of the heel. However, this pain can also manifest in the mid-foot area, creating a significant impact on mobility and quality of life. Generally, this condition affects one foot, but it can occur in both simultaneously.
Characteristic Pain Patterns
The pain associated with plantar fasciitis is unique in its pattern. It is most intense with the first steps after waking up or after long periods of rest, as the plantar fascia temporarily stiffens during these times. This initial pain typically subsides as the foot limbers up with movement. However, it can recur after prolonged periods of standing or when getting up after a rest or sitting for a long time.
Other Common Symptoms
Apart from the primary pain in the heel, other symptoms may include:
- A dull ache in the foot arch or heel.
- Swelling or redness in the affected area.
- Increased discomfort after exercise, not during it.
- A sensation of tightness in the plantar fascia, particularly in the morning.
Why Symptoms Matter
Recognising these symptoms early is crucial for effective treatment. Delaying intervention can result in chronic heel pain, which can hinder regular activities like walking or exercise. At Oswald Gibson Cape Orthotics and Prosthetics, we often encounter patients who have been enduring these symptoms for prolonged periods without realizing that their condition is treatable, or those who have followed the wrong advice.
Symptoms in Different Populations
It’s also worth noting that symptoms may vary slightly across different groups. For instance, athletes might experience symptoms predominantly after exercise, while those in occupations requiring long hours of standing might notice more consistent pain throughout the day.
Section 3: Causes of Plantar Fasciitis
Understanding the Underlying Causes
Plantar fasciitis is primarily caused by repetitive strain and stress on the plantar fascia, the thick band of tissue that supports the arch of your foot. When the foot is weight-bearing, a tremendous amount of force is concentrated on the plantar fascia, similar to the string on a bow. This pressure leads to stress on the tissue that results in small tears and inflammation., and pain. The exact mechanism behind these tears can vary, but several factors are known to contribute significantly to the development of plantar fasciitis.
Age-Related Changes
One of the most common factors is age. Plantar fasciitis is more prevalent in individuals between the ages of 40 and 60. As we age, the plantar fascia loses some of its elasticity and becomes more susceptible to tearing under stress.
Physical Activity
Certain types of physical activities that place a lot of stress on the heel and the attached tissue can also contribute to the onset of plantar fasciitis. Long-distance runners, ballet dancers, and aerobic dancers are among those at higher risk. Activities that involve a lot of walking or standing on hard surfaces can also trigger plantar fasciitis.
Foot Mechanics
The structure and mechanics of your feet play a significant role. People with flat feet, a high arch, or an abnormal walking pattern (like an excessive inward roll of the foot) can place extra stress on the plantar fascia. This irregular distribution of weight and pressure can lead to plantar fasciitis.
Weight and Obesity
Carrying extra weight can exert additional stress on the plantar fascia, especially if the weight gain is rapid. Obesity is a significant risk factor for plantar fasciitis because the additional weight strains the delicate tissues of the feet, leading to inflammation and pain.
Occupational Hazards
Certain occupations that require a person to spend most of their time standing or walking on hard surfaces — such as teachers, factory workers, and healthcare professionals — can increase the risk of developing plantar fasciitis. Continuous pressure on the feet without adequate rest can lead to chronic stress on the plantar fascia.
Improper Footwear
Wearing shoes with inadequate support or cushioning can contribute to the development of plantar fasciitis symptoms. Shoes that do not provide proper arch support or that have thin soles can fail to absorb the shock and pressure exerted on the feet, leading to increased strain on the plantar fascia.
The Importance of Understanding Causes
At Oswald Gibson Cape Orthotics and Prosthetics, we emphasise understanding these causes because it guides us in creating effective, personalised treatment plans. By addressing the specific factors contributing to each patient’s condition, we can offer more targeted and successful treatments.
Section 4: Treatment of Plantar Fasciitis
Treatment Overview
When it comes to treating plantar fasciitis, the objective is twofold: to relieve inflammation and pain and to address the underlying causes to prevent recurrence. This is where a combination of home remedies, professional medical treatment, and, if necessary, advanced therapies come into play.
Non-Surgical Treatments
Most cases of plantar fasciitis respond well to non-surgical treatments. These treatments, which can be easily implemented at home or with the help of a professional, include:
- Rest and Ice: Giving your feet a break from activities that cause pain and applying ice to the inflamed area can significantly reduce symptoms.
- Stretching Exercises: Stretching the plantar fascia, Achilles tendon, and calf muscles can relieve pain and improve foot function. Simple exercises, such as rolling a ball under the foot, massaging the fascia or towel stretches, can be highly effective.
- Orthotic Devices and Supportive Shoes: Custom orthotics, designed to cushion and support the arch of the foot, can redistribute pressure and provide relief from plantar fasciitis pain. Supportive shoes with thick soles and extra cushioning can also help.
- Physical Therapy: A physical therapist can demonstrate a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilizes your ankle and heel.
Read more about Plantar Fasciitis stretching exercises here.
Advanced Treatment Options
For those who don’t respond to initial treatments, or for more severe or stubborn cases, additional therapies may be considered:
- Extracorporeal Shock Wave Therapy (ESWT): This therapy directs sound waves at the area of pain to encourage healing. It’s typically considered when other conservative treatments have failed.
- Corticosteroid Injections: Injections of corticosteroid can provide temporary pain relief. These are usually guided by ultrasound imaging to ensure precise delivery of the steroid.
- Platelet-Rich Plasma (PRP) Injections: PRP involves injecting a concentration of the patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles, and joints.
The Role of Orthotics and Prosthetics
At Oswald Gibson Cape Orthotics and Prosthetics, we emphasise the importance of proper foot support in treating and preventing plantar fasciitis. Custom-designed orthotics are not just about cushioning; they’re about providing the right kind of support to correct abnormal foot mechanics. This can be crucial not only in treating plantar fasciitis but also in preventing its recurrence, and other compensatory symptoms.
Patient Education and Lifestyle Modifications
Part of the treatment plan also includes educating patients about lifestyle modifications. This might involve changes in physical activity, losing weight, or choosing footwear that provides better support and cushioning. Such changes can make a significant difference in managing symptoms and preventing future issues.