is a problem that affects far too many people, especially since the remedies for it are conservative
and effective. If the backs of your feet ache, don't ignore the discomfort or try to walk through it. The longer an issue like plantar fasciitis goes untreated, the worse it becomes and the harder it
is to treat.
A flattening or overstretching of your plantar fascia can cause microscopic tears, inflammation, and a burning sensation. While developing slowly, there may be a sudden severe event sometimes
occurring in only one foot at a time. Plantar Faciitis can affect people of all ages and backgrounds. Some contributing factors include age, weight-bearing activities, sudden increase in physical
activity, improper shoes, excess weight or a recent weight gain (as little as 5 pounds), and poor biomechanics (flat feet, high arches or unnatural gait).
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to
such an extent that the area becomes swollen (inflamed). In most cases, the pain is under the foot, toward the front of the heel. Post-static dyskinesia (pain after rest) symptoms tend to be worse
just after getting out of bed in the morning, and after a period of rest during the day. After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the
After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including. Whether your pain is worse at specific times of
the day or after specific activities. Any recent injury to the area. Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg. Your age and
occupation. Your recreational activities, including sports and exercise programs. The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair. Your doctor will
examine you, including. An evaluation of your gait. While you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of
your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and
decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care
professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the
results of your physical examination, you may need foot X-rays or other diagnostic tests.
Non Surgical Treatment
There are many treatments for fasciitis. The most common initial treatment provided by the family doctor are anti-inflammatory medications. They may take the edge off the pain, but they don't often
resolve the condition fully. Steroid injections, which deliver the medication directly to the most painful area, are usually more effective. Rest, ice, weight loss, taping, strapping, immobilization,
physiotherapy, massage, stretching, heel cushions, acupuncture, night splints and extra-corporeal shock wave therapy all help some patients. Many patients, however, have a biomechanical cause such as
excessively pronated feet to their complaint, and this may mean many of the treatments listed above will only provide temporary relief of fasciitis symptoms. When you stop the treatment, the pain
often returns. This is why many cases of fasciitis respond well to orthoses, custom-made inserts that control the mechanical cause of the complaint. If you're considering orthoses, it's very
important to have a podiatrist specializing in the field to examine you. There are many biomechanical factors to consider when assessing the need for literally dozens of types of devices available,
so you need to have an expert to properly assess you. (Unfortunately, as is the case in many jurisdictions, there is no minimum standard of training required in British Columbia to make orthoses, and
there are many fly-by-night operations around that employ salesmen with little, if any, training in understanding anatomy or foot function. The emphasis with these groups is on selling you some sort
of device, rather than providing proper assessment, treatment and follow-up.
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver
high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a
"numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National
Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are
uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies
found the procedure to be no better than a placebo (sham treatment).
You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are
prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your
feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.