Plantar fasciitis
Plantar fasciitis is a common condition that causes heel pain due to inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. Plantar fasciitis is one of the most common causes of heel pain. It is estimated to affect about 1 in 10 people at some point during their lifetime. It is common in athletes, particular runners, due to repetitive stress on the feet. Obesity is a significant risk factor because excess weight increases stress on the plantar fascia.
Symptoms
Symptoms include sharp, stabbing pain in the heel, particularly with the first steps in the morning, pain that worsens after long periods of standing or rising for sitting, or pain that typically decreases with activity (but may return after prolonged standing or exercise).
Plantar fasciitis is primarily caused by repetitive mechanical stress on the plantar fascia, leading to microtears and inflammation. Key etiological factors include:
- Overuse and Repetitive Strain: Activities that place excessive stress on the plantar fascia, such as running, dancing, or prolonged standing, can overload the tissue.
- Foot Biomechanics: Abnormal foot mechanics, including overpronation (excessive inward rolling of the foot), flat feet, or high arches, can alter the distribution of force across the foot, increasing strain on the plantar fascia.
- Age-Related Changes: Degenerative changes in the plantar fascia with aging, particularly in individuals over 40, can contribute to a decreased ability to absorb shock, making the fascia more susceptible to injury.
- Obesity: Increased body mass puts additional stress on the plantar fascia, increasing the risk of developing inflammation and pain, especially in individuals with underlying structural abnormalities.
- Improper Footwear: Shoes lacking proper arch support, cushioning, or flexibility, especially when worn for long periods, can exacerbate the strain on the plantar fascia. Heel height and shoe design also play a role in altering foot mechanics.
- Tightness of Adjacent Structures: Tight calf muscles, Achilles tendinopathy, or limited ankle dorsiflexion can increase tension on the plantar fascia, further exacerbating the condition.
- Occupational Factors: Jobs that require standing for prolonged periods or involve repetitive impact (e.g., factory workers, teachers, retail workers) are associated with higher risk due to prolonged loading of the foot.
- Inflammatory or Systemic Conditions: Conditions such as rheumatoid arthritis, ankylosing spondylitis, and reactive arthritis can predispose individuals to plantar fasciitis through inflammation and altered biomechanics.
Interventions
There are many conservative treatments and at-home modalities for plantar fasciitis.
Orthotics and footwear modifications can alleviate pressure on the plantar fascia, whilst night splints hold the foot in a dorsiflexed position, keeping the plantar fascia stretched and preventing morning stiffness.
Physical therapy and exercises can address the specific causes of plantar fasciitis.
Medical and Surgical Modalities such as (NSAIDs), Corticosteroid Injections, Platelet-Rich Plasma (PRP) Therapy and Surgery (in Severe Cases) can be recommended as part of a treatment plan.
Therapeutic ultrasound uses sound waves to increase blood flow and promote healing in the plantar fascia. This modality is often used in combination with other treatments, such as physical therapy, to speed up recovery.
SHOCKWAVE THERAPY
A study by Morrissey et al (2021) considered the efficacy of nine of the most popular interventions for Plantar Fasciitis based on Evidence Based Practice. The aim was to provide a Best Practice guide for treating Plantar Fasciitis. The published literature is dominated by systematic reviews, guidelines and meta-analyses that include low-quality trials with small sample sizes, which may inflate effect sizes and lead to incorrect interpretation. Following a mixed-method design including systematic review, expert interviews and patient survey:
- There was good agreement between the systematic review findings and interview data about taping and plantar fascia stretching for first step pain in the short-term.
- Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach.
- There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term, medium-term and long-term and radial shockwave for first step pain in the short-term and long-term
- We found good agreement to 'step care' using custom foot orthoses for general pain in the short-term and medium-term.
The authors showed Shockwave Therapy had the best evidence of modalities that were evaluated.
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