Understanding plantar fasciopathy
Written in association with:Plantar fasciopathy, commonly known as plantar fasciitis, is a prevalent condition characterised by pain in the heel and bottom of the foot. This ailment occurs due to inflammation, degeneration, or micro-tears in the plantar fascia - a thick band of connective tissue that runs along the sole, connecting the heel bone to the toes. Here to tell us more about the condition is esteemed consultant orthopaedic surgeon, Mr Georgios Kiziridis.
Causes and risk factors
Plantar fasciopathy often arises from repetitive strain on the plantar fascia, which can be caused by various factors. Overuse from activities such as running, prolonged standing, or walking on hard surfaces is a primary cause.
Additionally, structural foot problems like flat feet or high arches can increase tension on the fascia. Age is another risk factor, as the plantar fascia loses elasticity over time. Obesity and sudden weight gain also contribute by placing extra stress on the feet. Tight calves (affecting the ability to flex the ankle upwards) seem to be strongly related to plantar fasciopathy.
Symptoms and diagnosis
The hallmark symptom of plantar fasciopathy is sharp, stabbing pain in the heel, especially noticeable with the first steps in the morning or after periods of inactivity. This pain typically decreases with movement but can return after prolonged standing or physical activity.
Diagnosis is primarily clinical, based on patient history and physical examination. Doctors may perform a thorough assessment, including checking for tenderness along the plantar fascia. In some cases, imaging studies such as X-rays, MRIs, blood tests, and nerve conduction studies are used to rule out other conditions like fractures, nerve entrapments, etc.
Treatment options
Effective treatment for plantar fasciopathy often involves a combination of approaches. Initial treatments focus on relieving pain and reducing inflammation. Rest, ice application, and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended.
Stretching exercises targeting the Achilles tendon and plantar fascia can help improve flexibility and alleviate symptoms. Physical therapy may also be beneficial. For more severe or persistent cases, treatments such as orthotic devices, night splints, or injections might be considered. Extracorporeal shockwave therapy (ESWT) and, in rare cases, surgical intervention are options for those who do not respond to conservative treatments.
Calf stretches are also very beneficial. There is more and more evidence in recent years to suggest that tight calves are strongly related with problems of the feet. Therefore, it is believed that calf stretches can help with plantar fasciopathy.
The easiest and best way to stretch your calf muscles properly is by using a slant board at home every day. Stand on the slant board for 3 minutes x 3 times a day initially and gradually progress to a minimum of 5 minutes x 5 times a day for (at least) 3 months. You should always wear your trainers (with appropriate insoles) when you do this exercise. When calves remain tight despite regular stretching for a minimum of 3 months, then a small surgery to release one of the calf muscles can be considered.
Gastrocnemius muscle tightness and release is an operation that is usually performed under local anaesthetic and sedation, lasts about 10-15 minutes and you go back home within a few hours from surgery, fully weight bearing in a boot for up to 2 weeks. You may require regular pain killers for a few days, as the operated muscle will feel like ‘’bruised’’. As soon as you feel comfortable again, you should restart regular stretches on your calves.
Prevention and long-term management
Preventing plantar fasciopathy involves maintaining proper foot health and biomechanics. Wearing supportive footwear, especially during activities that put strain on the feet, is crucial.
Regular stretching exercises, particularly for the calves and plantar fascia, can help maintain flexibility and reduce the risk of recurrence. Managing body weight through a healthy diet and regular exercise is also essential in reducing stress on the plantar fascia. With appropriate care and preventive measures, individuals can effectively manage and reduce the impact of plantar fasciopathy on their daily lives.
