Plantar Fasciitis

Have you ever experienced pain that starts in the heel but spreads throughout the sole of the foot, and which is especially prevalent when taking your first steps in the morning or after having sat down for a prolonged period? If so, it could be a warning sign that you are suffering with plantar fasciitis.

Plantar Fasciitis, otherwise known as jogger’s heel, is a common condition among the over 40s. The possible causes of plantar fasciitis are as follows:
  • Spending long periods on the feet places huge strain on the ligaments in the heel, which is why people in occupations required to stand for 8 hours or more each day are at greater risk of developing the condition.
  • Obesity means more weight and stress is placed on the plantar fascia, thereby increasing the risk of developing the condition.
  • Unsuitable footwear such as shoes with no padding in the heel can also contribute to this condition developing.
  • Changes to regular types of activity, such as a large increase in running distance, and walking/jogging on more uneven or harder surfaces than usual (such as cement or concrete), are also risk factors.
  • Achilles tendon injuries is another possible cause as this can impair movement at the heel.
  • Rheumatoid arthritis or osteoarthritis in the heel could increase inflammation in the parts of the plantar fascia which connect to the bone, thus increasing the risk of developing plantar fasciitis.
  • Physical mechanics, such as being flat footed, overpronation, or calf ligament irregularities that affect movement at the ankle, are also possible causes.

The main symptom of plantar fasciitis is heel pain that spreads throughout the sole of the foot, including the arch of the foot in some cases. The pain itself is often a shooting, stinging type of pain, which only gradually worsens over time, making patients mistakenly believe that it is temporary, only for it to make a painful return. The pain is at its worst when the patient takes their first steps after a period off their feet, such as first thing in the morning or after having sat down for a prolonged period. Additionally, the pain often increases throughout the day and/or when the person is on their feet for a long time, such as when walking or standing, with the pain worsening the more they move.

Treatment for Plantar Fasciitis may take the following forms:
  • A course of NSAID medication.
  • The use of foot supports, such as arch supports and/or heel cushions.
  • Physical therapy involving training in how to stretch the Achilles tendon as this has been shown to be an effective form of treatment for the condition.
  • Steroid injections, although unpopular, have been shown to be effective in 98% of patients, although it can take up to 18 months for the condition to go away completely, while it has also been known to make a return after that.
Surgery is rarely used to treat this condition because of the risks and complications arising from its use, such as infections, chronic pain, and nerve damage that can lead to numbness or pins and needles. Moreover, surgery can sometimes cause a membrane to form that could result in flat footedness.

While this condition may not seem serious, there is still a need for patients to remain vigilant and not overlook its treatment because it has the potential to impact daily life significantly. For this reason, if you experience any heel abnormalities, you should consult a doctor who will perform a diagnosis and prescribe suitable treatment where necessary.

Written by Dr. Withoon Boonthanomwong, Orthopedic Surgeon at the Orthopedics Center, Bumrungrad International Hospital

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