Plantar Fasciitis: Fascia Inflammation, Causing Recurring Pain

     Plantar Fasciitis is caused by inflammation of the plantar fascia, a thick band of tissue located at the bottom of the foot. This condition commonly occurs where the fascia attaches to the heel bone. Individuals with plantar fasciitis often experience heel pain, especially when bearing weight on the foot. The pain is typically most intense during the initial steps after waking up or after prolonged sitting. As one continues to walk, the pain usually subsides. Similarly, pain tends to be more severe at the beginning of a run and may gradually improve with continued activity, only to return once activity ceases. In more severe cases, the pain can persist throughout the day.

Causes of Plantar Fasciitis

• Overuse or excessive strain beyond the body's tolerance, such as overtraining or running excessively long distances.
• Heel-striking while running, often seen in individuals who take long strides, which results in a significant impact on the heel.
• Running on hard surfaces or wearing thin-soled shoes that fail to absorb shock adequately.
• Excess body weight, as heavier individuals are at increased risk due to the greater impact force on the heels.
• Abnormal foot structure, such as high arches, flat feet, pronation (inward rolling), or outward heel tilting.

Symptoms of Plantar Fasciitis

     The primary symptom is heel pain that can extend across the sole, and in some cases, to the arch. The pain is often described as sharp or burning, and may begin mildly, leading individuals to underestimate it. However, the pain tends to return and intensify, particularly when placing weight on the heel for the first time, such as the first step out of bed or after a period of rest.

Additionally, the pain may increase throughout the day or after prolonged weight-bearing activities such as standing or walking. Movement can further aggravate the discomfort.

Treatment for Plantar Fasciitis

• Weight reduction is recommended for individuals who are overweight.
• Shockwave therapy is used in chronic cases, targeting the fascia attachment point. In the early stages, laser therapy may be applied.
• Most physicians begin treatment with oral medication, warm foot soaks, cold compresses, and stretching exercises for the plantar fascia and Achilles tendon.
• Steroid injections are generally discouraged.
• If symptoms persist after six months of conservative treatment, surgical intervention may be considered. This may involve either open surgery or endoscopic procedures to release the fascia attachment, thereby relieving inflammation and pain.
• The use of orthotic insoles or silicone heel pads, as well as wearing shoes with thick, soft soles, is recommended. Walking barefoot should be avoided.

Prevention of Plantar Fasciitis

• Choose appropriate footwear for daily activities to reduce impact from excessive walking or exercise. Shoes should have thick, cushioned soles and not be thin or rigid.
• Women who frequently wear high heels for extended periods should remove them during breaks and regularly stretch their calves.
• Individuals with abnormal foot structure, such as flat or overly arched feet, should consult a specialist to obtain custom-made orthotics to minimize injury and prevent plantar fasciitis.
• It is important to stretch the calves before and after running. In cases of severe pain post-activity, apply cold compresses to the heel.
• Maintain a healthy body weight.

Surgical Options

     Surgical options, whether open or endoscopic, aim to release the plantar fascia attachment to alleviate inflammation and resolve pain effectively.