Plantar fasciitis

The human foot is a region in which a number of bones, ligaments and tendons can be found and through it a great deal of load is transmitted on a daily basis. Plantar fasciitis can be described as an inflammatory state of the fascia and tiny ligaments of the base of the foot in the near vicinity of the heel bone (calcaneus). Plantar fasciitis falls into the gropu of overuse pain syndromes due to the fact that the pain occurs because micro damage accumulates and leads to degeneration of the colagen fibers in the fascia and ligaments in the sole. The degeneration and micro damage is caused by either too big or unsuitable loads being put on the sole of the foot.

The fascia at the sole of the foot, ie. the plantar fascia is situated below the skin and parted from it by a three-layerd fat tissue which is wider below the heel than it is in the rest of the foot. The pain occurs in the lower part of the heel bone and very often this syndrome occurs with individuals who are overweight. Earlier it was thought that the nature of this pain syndrome is an inflammatory process, but newer studies have shown that it is a case of degeneration, ie. accumulation of microdamage and stress to the sole of the foot that leads to its overuse and ultimately to pain. The pain occurs in the morning when the patient gets up and stands on the foot, which leads to the foot being stretched during walking, but the pain can also linger throughout the day and even grow in its intensity.

The causes for this state can be many, eg. use of low quality footwear which does not give substantial support to the sole of the foot leading to it getting flatened and the loads on its structures getting significantly bigger because of the compromised foot biomechanics. Athletes can have problems with this syndrome due to irregularities in the training process, such as unsuitable training intensity or extensity, sudden training intensity spikes, etc. Foot deformations, foot pronation (foot falling or rotating medialy), flat feet, valgus foot position, too tight or shortened Achilles tendon, etc., can also be a factor in the incidence of plantar fasciitis. Sedentary way of life, lack of physical activity, obesity or simply being overweight are all a seen as predisposing factors for develompent of plantar fasciitis. In general population plantar fasciitis most commonly occurs during the range of 40-60 years and with ahtletes it is most common with runners, especially long distance ones.

Treatment is aimed at removing the factors that have caused the pain, but it is also important, in the initial phase of treatment, to stop or lower the activities that are painful. Orthopaedic foot pads for individuals with foot deformations, choice of quality footwear, base of the foot, Achilles tendon and lower leg muscles stretching are also seen as effective tretment methods. Foot and calf massage, criotherapy, electrotherapy, ultrasound therapy and shockwave therapy are all used as forms of treatment in the conservative approach to this syndrome. Surgical approach, which is based on the release of the plantar fascia, ie. fasciotomy, is advised only if the pain and symptoms linger for longer than 6 months.

Prevention: chosing quality footwear and prthopaedic foot pads if needed, avoiding a sedentary way of life with long periods of sitting or standing still, stretching the lower leg and sole muscles, regular physical activity, maintaining a balanced body weight, etc.