Plantar Fasciitis: Causes, Symptoms, and Treatments

Plantar fasciitis is one of the most common conditions affecting the foot, causing pain and functional limitations. This pathology, which affects the plantar fascia, can significantly impact the quality of life of those who suffer from it. Understanding the causes, recognizing the symptoms, and knowing the treatment options are essential to effectively address this condition.

Mechanism of Action and Anatomy

To understand plantar fasciitis, it is essential to know the anatomy of the foot. The plantar fascia, also known as the plantar aponeurosis, is a strong band of connective tissue that extends from the heel bone (calcaneus) to the base of the toes. This structure plays a crucial role in supporting the arch of the foot and distributing body weight during walking and running.

Plantar fasciitis occurs when this fascia undergoes repeated microtraumas or excessive stretching. Contrary to what the name may suggest, it is not just an inflammation but a mixed disorder involving both inflammatory and degenerative processes.

The mechanism of action of plantar fasciitis involves several factors:

1. Microtraumas: Small repeated injuries to the plantar fascia can accumulate over time.
2. Overload: Excessive load on the fascia can lead to stretching and micro-tears.
3. Biomechanical alterations: Abnormalities in foot structure or gait mechanics can increase stress on the plantar fascia.

Conditions Treated and Ideal Patients

Plantar fasciitis mainly affects active adults between 30 and 60 years old. However, it can occur in individuals of any age, especially in the presence of certain risk factors. Conditions that may lead to the development of plantar fasciitis include:

1. Overweight or obesity: Excess weight increases stress on the plantar fascia.
2. Intense physical activity: Runners and athletes engaged in high-impact sports are particularly at risk.
3. Jobs requiring long periods of standing: Professions that involve prolonged standing can predispose to plantar fasciitis.
4. Structural foot abnormalities: Flat feet, high arches, or other biomechanical anomalies can increase the risk.
5. Inappropriate footwear: Shoes with poor arch support or excessively worn-out soles can contribute to the condition's development.

It is important to note that plantar fasciitis can present bilaterally in about one-third of cases, affecting both feet.

Symptoms and Diagnosis

The main symptom of plantar fasciitis is pain, which presents with specific characteristics:

1. Location: The pain is typically located under the heel and can extend along the arch of the foot to the base of the toes.
2. Temporal intensity: The pain is often worse in the morning, with the first steps after waking, or after prolonged periods of rest.
3. Evolution: Initially, the pain may decrease after a few steps but tends to increase with prolonged activity.
4. Progression: If untreated, the condition can worsen over time, making even normal daily activities difficult.

Diagnosis of plantar fasciitis is mainly clinical, based on patient history and physical examination. The doctor will assess:

1. The patient's description of symptoms.
2. The location and characteristics of the pain.
3. Factors that relieve or exacerbate the pain.
4. Physical examination of the foot, including palpation of the plantar fascia.

In some cases, imaging tests such as X-rays or ultrasounds may be requested, mainly to exclude other pathologies or to evaluate the presence of heel spurs, a condition often associated with plantar fasciitis.

Therapeutic Approaches

Treatment of plantar fasciitis is mainly conservative and aims to reduce pain, improve foot function, and prevent recurrences. Therapeutic options include:

• Rest and activity modification: Reducing activities that cause pain is essential to allow the plantar fascia to heal.
• Orthotics and supports:
  • Custom-made or prefabricated insoles can provide adequate support to the arch.
  • Night splints can keep the plantar fascia stretched during sleep.
• Physical therapy: A targeted exercise program can help to:
  • Stretch the plantar fascia and Achilles tendon.
  • Strengthen the intrinsic muscles of the foot.
  • Improve overall foot flexibility and stability.
• Pharmacological therapies:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), orally or topically, can help manage pain and inflammation.
  • In more severe cases, corticosteroid injections may be considered, although their use should be limited due to potential side effects.
• Physical therapies:
  • Ice application can help reduce inflammation and pain.
  • Techniques such as ultrasound therapy or extracorporeal shock wave therapy may be useful in some cases.
• Appropriate footwear:
  • Wearing shoes with proper arch support and cushioning can reduce stress on the plantar fascia. The best solution is to combine comfortable footwear with custom-made insoles.
• Weight loss:
  • In overweight or obese patients, reducing body weight can significantly alleviate foot stress.
• Surgery:
  • Surgical intervention is considered only in refractory cases, after at least 6-12 months of conservative treatment without significant improvement.

Prevention and Long-Term Management

Preventing plantar fasciitis and managing it long-term after initial treatment are crucial to avoid recurrences. Preventive strategies include:

1. Maintaining a healthy body weight.
2. Using appropriate footwear, especially during physical activity.
3. Gradual increase in exercise intensity.
4. Regular stretching of the plantar fascia and Achilles tendon.
5. Avoid walking barefoot on hard surfaces for prolonged periods.
6. Use preventive orthotic supports, especially if known biomechanical abnormalities are present.

Conclusions and Recommendations

Plantar fasciitis, while common, can significantly impact quality of life. Understanding risk factors, early recognition of symptoms, and adopting a multimodal therapeutic approach are essential for effective management.

Given the complexity of the condition and the variety of available treatments, it is crucial to consult an orthopedic specialist for an accurate evaluation and a personalized treatment plan. An individualized approach, taking into account the specific needs and characteristics of each patient, offers the best chances of success in treating plantar fasciitis.

Collaboration between patient and doctor, combined with a consistent commitment to following therapeutic recommendations, can lead to significant results, allowing a return to an active and pain-free lifestyle.

For more information, visit us at Orthopedics, Via Taramelli 21/23 in Bergamo or Contact Us!
We are available at phone number 035/212110 from Monday to Saturday, from 9:00 AM to 12:30 PM and from 3:00 PM to 7:00 PM, or by email at: info@ortopediazambelli.it

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