Do you suffer from plantar fasciitis? Don't worry, here's what it is and how to treat it

By Cristiano Antonino On May 7, 2023

Plantar fasciitis is one of the most common pathologies causing annoying heel and sole pain

In fact, 10 per cent of people contract this disease at least once in their life, and in 80 per cent of cases of heel pain, the cause can be traced back to this syndrome.

Due to the localisation of pain in the posteroinferior area of the foot, plantar fasciitis is one of the main causes of heel pain.

Among the people most affected by this condition are sportsmen and women, who strain the plantar fascia with repeated movements that lead to micro-lesions of the lagmentous structures.

Athletes suffering from this inflammation account for 80% of plantar fasciitis patients.

Although this number is very high, people who lead sedentary lives are also at risk, and the likelihood of having plantar fasciitis increases if there are other related conditions such as obesity and diabetes.

What is plantar fasciitis

Plantar fasciitis is a painful syndrome affecting the sole of the foot, particularly the heel.

This pathology, often of inflammatory origin, affects the fascia of the plantar muscles and is manifested by several symptoms, including severe pain.

Also known as ‘plantar fasciitis’, it is a very common pathology in the general population and, in particular, among athletes.

To understand specifically what plantar fasciitis is, it is important to have a basic knowledge of the structure of the foot.

Fasciitis in fact affects a particular ligament, called the arcuate ligament, which connects the inner plantar area of the calcaneus with the base of the toes.

Initially, inflammation of this area leads to severe pain in the heel, which can later move to the forefoot in severe cases.

Symptoms

The symptoms of plantar fasciitis are related to inflammation of the connective tissue that can degenerate.

The main symptom is a strong pain in the retrocalcaneal area that may occur at certain times of the day, for example when waking up after lying down for a long time.

Usually the pain is perceived as a strong twinge that subsides to reappear cyclically during the day following long periods of immobility, while it tends to subside with movement.

The pathogenesis of the pain on awakening is as follows: when lying down for a long time, the feet are relaxed and point downwards, in this position the arcuate ligament tends to retract.

In the morning, a lengthening of the plantar fascia is required to change position and stand up.

The plantar fascia remains contracted and the pain that characterises this pathology occurs upon waking.

The symptoms of plantar fasciitis can also occur after long periods of immobility, at the end of a strenuous sporting activity or after standing for many hours.

Causes of plantar fasciitis

The causes of plantar fasciitis are very varied and can change depending on the individual case.

Athletes are those who suffer most from this condition, but the main cause is not sport.

Risk factors for plantar fasciitis include:

Obesity or being overweight, which lead to increased pressure on the tendon;
flat foot syndrome;
inadequate shoes that do not help the person to have the right support on the plantar arch;
inadequate training, with little stretching and warm-up, which leads to micro-trauma in the foot;
the weakness of the leg muscles, which leads to an increase in the tension of the plantar arch necessary to maintain balance;
the loss of ligament elasticity, which may be the consequence of ligament degeneration;
the hollow foot which leads to abnormal tension of the plantar fascia;
the calcaneal spine which often causes irritation and contracture of the plantar fascia.

Diagnosis

Making a diagnosis of plantar fasciitis is indispensable in order to be able to start the therapy appropriate to the level of severity of the pathology.

Specialist examinations and tests are required to diagnose plantar fasciitis, with the aim of identifying the cause of the pain and ruling out other pathologies of the heel.

The first recommended step is a clinical examination in which the patient should describe in detail his or her symptoms, lifestyle and any previous interventions.

Following this first examination, more specific tests, such as X-rays and CT scans, may then be required to rule out certain foot diseases and to pinpoint more precisely where any inflammation is located.

In order to diagnose fasciitis, the doctor carries out a specific diagnostic test, which consists of strong pressure with the thumb on the heel.

This manoeuvre is carried out while the foot is in dorsiflexion and, if the patient suffers from fasciitis, he or she will report severe pain.

In the opposite case, it is likely that it is not plantar fasciitis.

Care and treatment

Treatments for plantar fasciitis are different and can change depending on the cause of the condition.

Complete healing is facilitated if the diagnosis is made early.

The usual remedies for plantar fasciitis are rest, ice and stretching exercises.

Resting the foot is essential in order to alleviate painful symptoms and reduce inflammation and pain.

Resting from training or sports activities allows the area to be prepared for subsequent treatment.

Straining the foot and continuing to make incorrect movements can lead to degeneration of the plantar fascia tissue, resulting in chronicity of the pathology.

In this case, any treatment would be ineffective as the foot will continue to be painful.

Ice is used to reduce the pain, relieve it, and enable the subject to be able to embark on a course of treatment.

Usually the foot is treated with ice during the acute phase, to reduce the pain, but it can also be useful to apply it for a quarter of an hour three or four times a day, thus preventing any recurrence.

Exercises for plantar fasciitis can also be very useful, as they improve the mobility of the affected area.

Among the most commonly used treatments for plantar fasciitis are anti-inflammatory drugs that can be taken both orally and topically.

In addition, it is often necessary for sufferers of fasciitis to use orthotics that are able to support the foot during sports and daily activities.

There are also night braces that aim to keep the foot in daytime position, reducing morning pain.

Exercises for plantar fasciitis

Stretching for plantar fasciitis is indispensable in order to help the tissues of the heel stretch, so as to reduce pain and improve the condition.

There are several exercises for plantar fasciitis, but among the most common are:

the exercise against the wall, which involves standing facing a wall. In this position, one must move the foot affected by the fasciitis behind and the healthy one forward. Approximately one metre from the wall, one must place one’s hands, leaning the upper body slightly forward, and stretch the calf. This exercise is usually repeated three or four times for about 20 seconds. The further away from the wall, the more you need to lean;
Another exercise often practised at the beginning or end of training is performed in a standing or sitting position. In this case, a napkin must be grasped from the floor with the foot affected by the pain, using the tips of the fingers. The exercise consists of lifting the napkin and dropping it about twenty times;
an exercise sitting on the floor involves stretching the sole of the foot in pain forwards, while that of the healthy foot is stretched backwards. In this position, an elastic band is placed on the heel and pulled with the hands from the ends. In this way, the movement with the foot can also be performed with the help of the rubber band. This exercise should also be repeated for about 30 seconds and three or four repetitions. A towel can be used as an alternative to the elastic band.

Plantar fasciitis and surgery

Among the therapies for plantar fasciitis is surgery, which involves the sectioning of the plantar fascia.

Until a few years ago, the operation involved disconnecting the fascia at the level of the heel or removing the area affected by the inflammation.

Today, in the most extreme and painful cases, it is preferred to intervene by percutaneously disrupting the plantar fascia.

The innovation of this method lies in the less invasive nature of the surgery, as a small incision is all that is needed to stretch and re-establish the circulation of the hypoperfused tissue.

In this way, the operation is not only simpler but also quicker: in just 15 minutes, surgery can be performed, after which it only takes two weeks to return to full movement.

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