Plantar fasciitis is when the plantar fascia ligament becomes inflamed. The plantar fascia ligament starts at the bottom of the heel and extends into the arch and midfoot to the bases of the toes. Often the ligament is irritated at the origin on the heel attachment therefore giving “heel pain.” The ligament can become inflamed anywhere from the heel attachment to the arch and midfoot to the toes but most commonly, plantar fasciitis is symptomatic under the heel. Once the ligament is irritated, it causes swelling and inflammation in the area and pain.
If this inflammation is not treated properly, plantar fasciitis can be symptomatic for a long time. Once the inflammation has been present for more than 6-9 months, it is considered “long-standing” and “chronic.” In these cases, plantar fasciitis is called plantar fasciosis. While “-itis” implies “inflammation of,” “-osis” implies chronic degeneration without inflammation. It happens when the body has lost its ability to heal an injury, we see less blood supply to the area, and cellular degeneration of the tissue occurs. In these cases, there is evidence of microscopic tears or injury to the actual ligament.
Plantar fasciitis and plantar fasciosis is the most common foot problem we see.
Causes
There are many things that can cause plantar fasciitis. Because the plantar fascia ligament is a fibrous, shock-absorbing band of connective tissue, any extra strain or tension can irritate it and set off plantar fasciitis.
- Foot type – if the arch is too flat or too high, it can lead to extra, long-standing, anatomical strain
- Prolonged standing – changing to a job where you are on your feet more can set off plantar fasciitis
- Prolonged activity
- Sudden weight gain
- Obesity and high body mass index
- Participating in a sudden, new exercise activity, especially if not wearing supportive shoes and inserts
- A tight calf muscle and achilles tendon
Symptoms
- Pain to the bottom of the heel or arch of the foot
- Pain can be worse with the first few steps after getting out of bed
- Pain can be worse when first getting out of chair after sitting for a while
- Heel pain can also worsen with activity or with standing for a while
- The pain typically has a gradual onset over time and progresses if not treated
- The pain can be with any normal activity if you are barefoot or lack support
- Pain can be worse if standing on hard floors, especially if barefoot or lack support
Diagnosis
Plantar fasciitis can be diagnosed after a full medical history and foot examination. There is a list of tests to rule out all other etiologies of heel pain. X-rays can be taken to see if there is a heel spur present. The spur is present in many people without the pain of plantar fasciitis, as well as people with plantar fasciitis pain do not always have heel spurs. This implies that the heel spur is probably not what is causing the pain but it’s the plantar fascia ligament and its damage and/or inflammation giving the heel symptoms.
– Dr. Annalisa Co, Olympic Foot and Ankle
