(Also) occupational diseases: all causes and remedies of plantar fasciitis
Plantar fasciitis: a frequent ailment that can affect everyone, from professional runners to… ambulance workers, also due to the ‘wrong’ shoes
Plantar fasciitis is one of the most common causes of foot pain
It is mainly suffered by sportsmen and women, but also by people who move little, are overweight or obese.
It can also be triggered by the frequent use of flat-soled or high-heeled shoes, or by protective shoes that are not suitable for that specific type of foot.
This is a very common condition, as it affects an area of the foot, the plantar fascia, which is stressed and ‘stressed’ with practically every step.
In the most serious cases, the pain can be continuous and so intense as to make walking difficult and uncomfortable, forcing people to rest.
This is why it is important not to underestimate it.
Plantar fasciitis, one of the first causes of foot pain
The term plantar fasciitis refers to a painful syndrome of the foot that generally affects active adults between the ages of 30 and 60.
It is one of the most common causes of foot pain, occurring bilaterally in 1 in 3 people, and in 50% of cases the condition is also associated with a calcaneal spur (a particular inflammation of the heel due to the formation of bone tissue).
Although the term ‘fasciitis’ suggests inflammation, it is actually a mixed inflammatory and degenerative disorder.
It specifically affects the plantar fascia, also known as the arcuate ligament or plantar aponeurosis, which is the fibrous tissue that extends from the calcaneus (the bony element that makes up the heel) to the base of the toes.
Plantar fasciitis causes pain that is initially localised under the heel and then, if neglected, extends to the base of the toes.
It is a painful symptom that has very specific characteristics:
- it is more acute in the morning when you get out of bed, or after standing for a long time (for example, after a long plane or car journey or after watching a film in the cinema);
- it tends to decrease after taking a few steps.
Neglecting the discomfort and postponing the start of treatment can cause the pain to worsen in intensity and duration and to become chronic, making recovery more difficult.
The causes of plantar fasciitis
The plantar fascia plays a fundamental role in maintaining the plantar arch and in transmitting and distributing body weight to the foot, both in static conditions and while walking, and is therefore an area that is physiologically subject to repeated stretching.
Excessive tension, particularly in the heel area, can cause an inflammatory process.
In addition, constant overloading can cause real microtraumas that, over time, can lead to degenerative phenomena of the collagen with consequent structural alterations and swelling in the perifascial area, giving rise to plantar fasciitis or calcaneal enthesopathy of the plantar fascia.
Important risk factors may also be
- the conformation of the foot, e.g. flat foot, hollow foot or foot with excessive pronation;
- reduced extensibility of the structures at the back of the foot and the Achilles tendon;
- weakness of the plantar flexor muscles.
These factors can cause an increase in the tension of the plantar fascia during the heel strike phase and especially when it is detached from the ground, and can also affect the ability of the fascia to absorb shocks.
The onset of the disorder is also affected by:
- advancing age and the consequent decrease in elasticity of the plantar muscles and ligaments;
- being overweight or obese;
- working in jobs that require weight-bearing and/or standing for many hours a day in shoes that are often too stiff.
Fasciitis caused by the ‘wrong’ shoes
Wearing the ‘wrong’ shoes is another important risk factor.
Excessive strain on the plantar fascia is caused by shoes with:
- too rigid sole
- soles that are too soft or
- flat sole
- heels that are too high.
These types of soles do not provide support for the plantar arch, while shoes with heels that are too high promote the shortening of the Achilles tendon.
Plantar fasciitis in athletes
Plantar fasciitis is a very common disorder in athletes who practice running or jumping activities (athletics, basketball, tennis, football) and in dancers.
In runners in particular, who are most affected, it is believed that plantar fasciitis is caused by an overload injury to the plantar fascia and microtrauma due to:
- incorrect training and on inappropriate surfaces;
- altered ankle/foot alignment;
- muscle dysfunction and stiffness;
- use of unsuitable footwear.
The diagnosis of plantar fasciitis is clinical and can be made by the physiatrist or orthopaedic specialist based on the objective examination conducted in the outpatient clinic and the person’s medical history.
If considered appropriate, the specialist may request some diagnostic radiological tests (such as X-rays, muscle-tendon ultrasound or nuclear magnetic resonance imaging) to exclude that the cause of the pain does not derive from other pathologies.
Plantar fasciitis rarely has a spontaneous resolution of symptoms.
In 90-95% of cases, however, it is cured by conservative (non-surgical) treatment alone, which aims to:
- reduce pain
- recover joint mobility
- strengthening the muscles.
In very few selected cases, surgery is required.
Remedies for plantar fasciitis
When the disease is in its acute phase, it is advisable to rest and avoid activities that may accentuate the discomfort (e.g. running, jumping, wearing very low or high-heeled shoes, etc.).
To alleviate the pain, ice can be applied locally and, if the pain is very intense, non-steroidal anti-inflammatory drugs (NSAIDs) can be taken on medical advice.
A key role in the recovery and healing of plantar fasciitis is played by physiotherapy.
The Individual Rehabilitation Programme aims to:
- reduce pain
- recover muscle-tendon-ligament extensibility;
- improve the proprioception of the ankle and foot;
- recover ankle joint mobility;
- strengthen muscles;
- improve gait pattern and walking.
Recovery times are quite long, up to 6 months and sometimes even 1 year, and require the patience and full cooperation of the person.
Specifically, the following are fundamental
- stretching or lengthening exercises of the calf muscles and the plantar fascia;
- proprioceptive exercises, to be performed several times a day.
Along with the exercises, it is possible to combine physical therapies such as:
- tecar therapy
- laser therapy;
- ultrasound therapy;
- focused shock waves.
Focused shock waves
Focused shock waves are one of the most effective treatments for plantar fasciitis.
The mechanism of action is very complex and is still being studied, but it appears to have an important pain-relieving, deflating and anti-inflammatory effect.
Moreover, this therapy is able to stimulate the activation of biological tissue repair processes.
However, since the effects of shock waves on tissues are closely related to the dosage used (power and number of shocks), it is important to rely on specialised centres.
In order to limit the risk of developing this pain syndrome, it is important to try to keep body weight under control to minimise stress on the arch ligament of the foot.
To do this, it is advisable to eat a balanced diet and exercise regularly (even half an hour of walking a day is sufficient).
Wearing the right shoes is also important for non-athletes. Footwear should have soles with a good cushioning effect and good arch support.
In general, it would be better to limit the use of shoes with soles that are too hard or too flat or with very high heels,’ concludes the specialist.