What is plantar fasciitis?

What is Plantar Fasciitis?

Plantar Fasciitis is a painful condition affecting the feet, in particular the heel and fascia which is like a ligament that stretches from the heel to the middle foot bones, it supports the arch of your foot and acts as a shock absorber.
This condition can be very difficult to treat due to the constant trauma that area is put under from walking, jogging, running etc, which is why it can take up to a year or longer to settle down. The typical symptoms are pain first thing in the morning after the feet have been rested over night and at the end of the day. There is usually one spot being the main source of pain and is located about 4cm forward from the heel and it maybe tender to press. Plantar Fasciitis is fairly common with 1 in 10 developing it between the ages of 40-60 years and is twice as common in women as it is in men.
Below is a picture showing the anatomy of the foot and identifying the Plantar Fascia.

What causes it?

There are different reasons as to why some people develop this problem and it is believed that repeated small injuries to the fascia cause it. The injury is usually near to where the plantar fascia attaches to the heel bone.
I found a good article from http://patient.info/health/heel-and-foot-pain-plantar-fasciitis which gives a good description of causes and treatment of Plantar Fasciitis which I have extracted below.

• If you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it or have previously had a more sedentary lifestyle.
• If you have recently started exercising on a different surface - for example, running on the road instead of a track.
• If you have been wearing shoes with poor cushioning or poor arch support.
• If you are overweight - this will put extra strain on your heel.
• If there is overuse or sudden stretching of your sole. For example - athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc.
• If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia.

A common wrong belief is that the pain is due to a bony growth, or 'spur', coming from the heel bone (calcaneum). Many people have a bony spur of the heel bone but not everyone with this develops plantar fasciitis.

Another possible reason for developing this condition is if you are flat footed and have over pronation,
I came across a very informative site called www.painscience.com which explained Plantar Fasciitis in more depth than anywhere else on the web that I could find, it goes into great detail of what it is, the possible causes and treatment options, each one is backed up with science. I have included a couple of extracts below from the site that I found very interesting and relevant.

The plantar fascia is not really a tendon: it’s a sheet of connective tissue (“fascia”), more like a ligament than a tendon. It stretches from the heel to toes, spanning the arch of the foot, from bones at the back to bones at the front (whereas tendons connect muscles to bones). The arch of the foot functions like a bow (as in a bow and arrow), and the plantar fascia is like the string of the bow. The tension in the “bow string” holds the shape of the arch. But every time you step, the “bow string” stretches… and when stretched too hard and too often, it gets irritated, and then it’s like a bow shooting you in the foot!

 Pronating is rolling the foot inward. It is almost synonymous with having flat feet, because the arch tends to collapse as you roll the foot inward. They don’t necessarily go together, but they often do, and they are both routinely claimed as root causes of plantar fasciitis. Personally, I think therapists just like to accuse their patients of “pronating” because it makes us sound like we know what we’re talking about. Sound a little harsh? Some experts believe the idea of pronation is so useless — and yet so common! — that they have called for it to be abolished

 Article is from science writer Paul Ingraham for full article please check out /www.painscience.com/tutorials/plantar-fasciitis.php

My personal experience of Plantar Fasciitis

I have only just been diagnosed recently so am on a long journey, I had been suffering from burning feet for about 6 months prior to this but thought it was just part of my connective tissue disorder (Ehlers Danlos Syndrome) this is covered in another post, so didn't get any help, when the pain was getting worse especially mornings and evenings and at times my feet would feel like i was walking on hot coal. I did some research into possible problems it could be and decided to pay to see a podiatrist, as they are the experts in problems affecting the feet. She carried out a thorough examination of the structure of my feet and commented on the blueness of my toe nails due to my poor circulation, she also looked at my feet from different angles when I was standing to see what my ankles were doing. She commented how hypermobile both feet were and how I over pronate, which means my ankles roll inwards, I knew about this part from other medical people I had seen in the past for my EDS, then she diagnosed me with plantar fasciitis in both feet and made a comment about the shape of my feet not being "ideal" as they have to compensate due to the structure by over pronating, as I wouldn't be able to walk on the side of my foot. She said I need to try and reduce my pain symptoms first before I have custom orthotics made for me, as they are too inflamed at the moment to cope with them. The orthotics will hold my foot in the right position, which will hopefully take the stress off the fascia (connective tissue).
I saw my G.P to get a referral to NHS podiatry but instead she referred me to my local hospital who deal with this condition and can give me specific exercises to help. I feel I am on the right path to treating this painful condition.

Treatment options:

Treatment is conservative and may consist of the following, a combination of different things may help speed up the recovery time. Fascia tissue heals quite slowly 

• Sleeves- These are like thick socks that are open toed, they compress the area to reduce inflammation and can be worn all day to help with pain. 
• Pain Medication- You can use anti-inflammatory creams, gels if you are unable to take tablets or just simple pain killers like Paracetamol 
• Orthotics- Used in your shoes to support the foot, these can be bought or custom made for you
• Rest- This should be done as much as possible to ease the pain. Avoid running, excess walking or standing and undue stretching of your sole. Gentle walking and exercises are fine, walking upstairs or on tiptoes can aggravate the fascia .
• Footwear- Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support. A laced sports shoe rather than an open sandal is probably best. Avoid old or worn shoes that may not give a good cushion to your heel.
• Pads and shoe inserts- These are used to cushion the heel and support the arch of your foot. They work best if you put them in your shoes at all times. The aim is to raise your heel by about 1 cm. If your heel is tender, cut a small hole in the heel pad at the site of the tender spot. This means that the tender part of your heel will not touch anything inside your shoe. Place the inserts/pads in both shoes, even if you only have pain in one foot.
• Frozen peas- Wrapped in a T-towel and applied to the area for 15-20 mins can ease the pain, you can also use gel packs from the fridge.
• Exercises- Gentle stretching of your Achilles tendon and plantar fascia, may help ease your symptoms as Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. This is because most people with plantar fasciitis have a slight tightness of their Achilles tendon. If this is the case, it tends to pull at the back of your heel and has a knock-on effect of keeping your plantar fascia tight. Also, when you are asleep overnight, your plantar fascia tends to tighten up (which is why it is usually most painful first thing in the morning). The aim of these exercises is to loosen up the tendons and fascia gently above and below your heel. Your doctor may refer you to a physiotherapist for exercise guidance.

If these conservative treatments don't work in helping ease the symptoms then there is:

•  Steroid injections- They can help by reducing the pain for a few weeks but doesn't always cure the problem, sometimes two or three injections are tried over a few weeks and maybe leave you sore afterwards.

• Extracorporeal shock-wave therapy- A machine is used to deliver high-energy sound-waves through the skin to the painful area on the foot. This procedure appears to be safe but it is uncertain how well it works. This is mostly because of a lack of large, well-designed clinical trials. You should have a full discussion with your doctor about the potential benefits and risks.
• Surgery- This is only considered in very difficult cases where the pain is not easing and been going on over 12 months and all other treatments have failed. There is always risks with any surgery. 

I am not a medical professional or had any medical training and some of the information provided is based on my own personal experience and advice I have been given but is not a replacement for seeing your G.P to discuss your individual case with them. Some of the information has come from a medical site but this is based on general advice only. Always discuss any concerns with your G.P