Plantar fasciitis, also known as heel-spur syndrome is a widespread problem amongst people who are active in sports, particularly runners. It starts as a dull, intermittent pain in the heel. If not treated correctly, it will progress to a sharp, persistent pain. Dr. Kevin Yip tells how the condition can be managed.
What is plantar fasciitis?
Plantar fasciitis is an inflammation of the plantar fascia, which is a thick band of tissue that runs from the heel of the foot to the toe. The pain is generally characterised as a dull, aching pain. In some cases, it can be a sharp, acute pain due to the inflammation.
What are the causes of plantar fasciitis?
The main cause of plantar fasciitis is due to overuse – such as running or standing all day. Teachers and factory supervisors who stand all day tend to get it due to increased pressure placed on the plantar fascia. We see it amongst long distance runners too. However, overuse is not enough to cause plantar fasciitis. We usually examine risk factors as well. One of them is the tightness of the calves, which is one of the leading causes of plantar fasciitis.
Another risk factor would be foot abnormalities. These include high arch foot (pes cavus) or flat-footedness (pes planus). In pes cavus, tension underneath the foot is going to be very high. With flat-footedness, the arch tends to collapse, creating a ‘windshield wiper’ effect. The bottom of the foot keeps rolling in, rendering it unstable.
Obesity is another reason – the extra weight can cause excess stress on the plantar fascia. Women may be more prone to develop plantar fasciitis due to long term use of high heels leading to tightening of the calves.
What are the signs and symptoms of plantar fasciitis?
Pain in the heel. This is most significantly felt in the mornings, during the first step of the day. Athletes, who run a lot, will feel it at the end of a run. The pain will be worse the following morning.
What can an athlete do to relieve the pain?
Painkillers can be taken or athletes can undergo the RICE therapy which is Rest, Ice Compression, Elevation therapy. It has an anti-inflammatory effect. The next step would be to reduce risk factors, which should be the highest priority. Daily stretching of the calves and the toes helps to stretch the plantar fascia, and bring some relief.
What are the other forms of treatment like for plantar fasciitis?
When the pain gets better. we start to strengthen the calves. Another way is to again look at reducing risk factors such as foot abnormalities.
Abnormal motion of the foot when walking such as overpronation, can be corrected with orthotic insoles, which we would get from a podiatrist to be custom made. A night splint is also used to keep the foot at 90 degress angle to maintain the pressure on the plantar fascia. Cortison injections are another form of approach in dealing with plantar fasciitis. It brings immediate relief but comes with side effects such as weakening of the tendons.
Shockwave therapy is another method that helps to promote our own body’s self healing mechanism to heal the plantar fascia naturally.
What is the rehabilitation process about for plantar fasciitis?
We start with the stretching and strengthening exercises. At more advanced levels, we move on to agility exercises like walking and running biomechanics as well as balance exercises. There has to be a certain degree of recovery before this stage can be reached.
What are the ways to prevent plantar fasciitis?
Regular stretching exercises and strengthening of the calves are crucial when it comes to preventing plantar fasciitis. Use of appropriate footwear is also important.