Those who have a physically active life, especially runners, are more prone to injuries. Despite being fundamental to health, physical activity can facilitate falls and inflammatory processes.
Among them is plantar fasciitis. The name may not be well known, but the symptom is: pain in the sole of the foot.
It can be located close to the heel and extend across the sole. Sometimes, the pain is quite intense, making the person need to get away from sports or exercises, and may even impair routine, such as walking short distances.
Plantar fasciitis is an inflammation of the plantar fascia, a tissue that extends from the sole of the foot connecting the heel to the toes. It is a common and painful condition triggered by stress and excessive effort in the region.
The disease usually causes pain in the sole of the foot, discomfort when walking or running and feeling of sensitivity. Plantar fasciitis is one of the most common pathologies that affect the foot and presents an obstacle to the patient to perform any activity that involves movement.
The treatment of plantar fasciitis is necessary to achieve a cure and not trigger other similar diseases, such as heel spurs.
Plantar fasciitis and the heel spur
Because they occur in similar regions, both diseases are often confused. However, they are not the same.
While plantar fasciitis is inflammation in the sole of the foot, the heel spur is a bony protuberance that grows at the base of the heel bone, close to where the plantar fascia attaches.
Both have similar causes, through multiple traumas or overload in the area of the feet, but they differ in the diagnosis.
The tests performed for plantar fasciitis include analysis of the patient’s history and procedures that cause pain in the area affected by the inflammation.
The heel spur should only be diagnosed through imaging exams, as its presence may or may not manifest symptoms.
Spur and plantar fasciitis can occur separately or together. The fascia, after long periods of inflammation, can cause the spur. On the contrary, only 5% of patients with heel spurs start to present pain and inflammation in the sole of the foot.
The fascia is a fibrous tissue that lines the muscles of different parts of the body and, in the case of the plantar fascia, its main function is to cushion the impact while the feet perform movements on a surface. When there is excessive effort, pressure and repetitive actions, tissue stress occurs and, consequently, the inflammation called plantar fasciitis.
Usually, the disease occurs only in one foot, but it can be bilateral. The causes of plantar fasciitis can be related to the following situations:
Continued use of high heels usually leads to decreased mobility of the Achilles tendon. Shortening this muscle, which connects the calf to the ankle region, favors plantar fasciitis.
Foot strain in heavy training and long distance running, especially on hard surfaces, such as asphalt, press the soles of the feet. Runners are often hit by inflammation, due to not wearing appropriate shoes to exercise or the prolonged use of the same sneakers.
Shortening of the posterior leg muscles or tensions in other parts of the body, such as an uneven hip, can inflame the plantar fascia and cause disease.
Genetic changes in the feet, or even an abnormal walking pattern, can affect how weight is distributed throughout the body when standing. Two known forms of changes in the shape of the feet are:
- Very hollow foot: more rigid and less efficient in absorbing impacts, which causes shortening of the fascia;
- Flat foot: commonly known as flat foot. It also presents difficulty in absorbing impacts, generating a continuous stretching of the plantar fascia.
Other factors that can trigger the disease:
- Some antibiotics weaken the tendons and can cause the Achilles tendon to rupture, such as ciprofloxacin (Cipro) or Levofloxacin (Levaquin);
- Being overweight puts your feet under greater pressure;
- Use of inappropriate shoes that do not provide adequate support for the arch of the foot, such as, for example, flat-soled shoes;
- Having certain diseases, such as rheumatoid arthritis or lupus;
- Traumatic conditions such as ankle sprains.
Plantar fasciitis is a common inflammation in middle-aged men and women, between 40 and 60 years old, especially when they are overweight. Other groups that are at risk of contracting the disease:
- Individuals who wear high heels frequently;
- Obese, especially the female population;
- Patients with genetic alterations, such as shortening of the leg and flat or hollow foot;
- Athletes, mainly runners, jumpers, dancers and walkers;
- People who need to stand for many hours during the day.
Symptoms of plantar fasciitis are the result of thickening of the fascia, the presence of fibrosis (increased fibers in a tissue) and calcification of the tissue. Therefore, the most common complaints are:
Pain in the sole of the foot near the heel
It is quite common for a person to be able to identify the pain as originating in the heel. Often, it can radiate towards the data, affecting the entire sole of the feet.
It is also possible to experience pain when standing for a long time, climbing stairs, wearing high heels or practicing physical activities, especially walking and running.
In most cases, the pain and tenderness in the feet remain throughout the day and are relieved after a short period of rest. In more serious situations, the pain spreads to the fingers and ankle.
Pain and burning after rest
Generally, the pain in the soles of your feet is most severe in the morning, after waking up, or after a period of rest. Usually, this pain tends to be more intense in the first 10 minutes, after starting the movement, being able to reduce and return again later.
Sensitivity in the sole of the foot
Many people may perceive the sole of their feet to be sensitive to touch, with pain or burning worsening when there is more pressure in the region.
Swelling and redness
Due to inflammation, swelling in the ankle region, redness and stiffness can occur, making it difficult to move the heel.
The diagnosis can be made by the orthopedist or physiotherapist. The exams are performed based on the analysis of the patient’s symptoms and specific tests that cause pain in the area affected by the inflammation.
The health professional should focus on discovering the cause of plantar fasciitis, thus starting with the patient the appropriate treatment to regress the inflammation and prevent its return.
An investigation of the patient’s history is carried out, evaluating the conditions that are exposed in the work environment and when performing sports.
It is also necessary to analyze the shape of the arch of the individual’s foot and whether the shoes they usually wear are suitable for the activities they perform.
To exclude the possibility of pain being caused by a neurological disorder, the patient must walk on tiptoe and heel for symptoms to be assessed. The exact location of plantar fasciitis can only be determined after the region is palpated and compressed.
From these small tests, the doctor also looks for signs of stiffness to ensure that the symptoms are not caused by joint limitation.
Imaging exams, such as radiography, are not able to identify plantar fasciitis, but the specialist doctor may order one to rule out the presence of the following diseases:
- Bone spur;
- Stress fractures;
- Tarsal tunnel syndrome (tibial nerve compression);
- Repeat syndrome (rheumatic disease);
- Sprained ankle.
Does plantar fasciitis have a cure?
Plantar fasciitis is curable, but the treatment is slow, lasting about 1 year to 18 months, and it depends on the patient performing it correctly so as not to strain the fascia any further. Methods range from home procedures, use of analgesic or anti-inflammatory drugs and physical therapy.
What is the treatment?
The goal of treating plantar fasciitis is to deflate the region with the intention of improving blood circulation and, if there are nodules, to remove them from the tendons.
- Shock waves: in this procedure the waves are directed to the area of heel pain in order to stimulate healing. It is usually used for chronic fascitis that does not respond to more conservative treatments;
- Tenex procedure : a minimally invasive procedure that removes damaged tissue from plantar fasciitis without needing surgery. Under the ultrasound guide, the doctor inserts a special needle through the skin and reaches the inflamed part of the tendon. The needle vibrates quickly and soon the fabric can be aspirated and removed;
- Reflexology: therapy that consists of applying pressure to certain reflexive points of the foot, in search of energy imbalances. The physiotherapist performs a massage to stimulate the sensitive area, bringing the benefit of reducing tension, balancing the body’s energy, improving blood supply and fighting stress.
Stretching does not cure plantar fasciitis, but it does help to relieve symptoms temporarily. The patient should not perform any of the following procedures without first consulting with a specialist doctor.
- To strengthen the musculature, pull a towel with your toes doing 10 to 15 repetitions, 3 to 4 times a day;
- Stretching the sole of the foot and calf, stretching the leg on a slightly inclined surface for 1 minute. Perform 3 sets of 15 repetitions;
- Pull the tip of the foot with your hand and press it against the wall for 30 seconds.
- Flexion of the fingers with rolling of the foot under a tennis ball. The movement helps to decrease the tension in the plantar fascia, hence the pain. Perform 10 to 15 minutes twice a day;
- Lean against a wall with one knee straight, the other bent and the heel on the floor. The foot and heel lengthen as the body is tilted. The patient must hold the position for 10 seconds before relaxing, repeating another 20 times;
- Lean and lean on a bench, separating your feet facing each other. Bend your knees and lower yourself, keeping your heels fixed on the floor. With each 10-second descent, the heels and sole of the foot will stretch. Repeat 20 times.
To immobilize and assist in stretching the fascia, it is recommended to use anklets during the day and splints at night.
However, immobilization is rarely the best way out. Re-education of physical activity, use of insoles and specific exercises are indicated as the most effective solutions.
The application of acupuncture affects pain and inflammation, and when associated with other forms of rehabilitation, it helps to reduce overload on the feet (combined with the use of insoles) and to restore strength and flexibility (combined with the practice of exercises ).
In a few cases, infiltration with corticosteroids can be performed, a method avoided due to the possibility of future problems, such as rupture of the fascia. The injection may provide temporary pain relief.
Some studies have also shown benefits with botox injection . Botulinum toxin is injected into the plantar fascia to cause nerve palsy, which generates temporary reductions in pain, a similar response to the use of corticosteroids.
There is no guarantee that the effect will last in the long term, as the applications do not offer a cure for the lesion.
Usually, the recommended treatment for plantar fascia is exclusively conservative, however, partial plantar fasciotomy is indicated after the failure of any other method during 12 months of trial or after rupture of the fascia.
Plantar fasciotomy aims to relieve pressure from the fascia region, but does not guarantee that symptoms will improve.
The procedure partially releases the plantar fascia, but there is a risk of total release and triggering problems, such as acquired adult flatfoot.
Medications: which anti-inflammatory for plantar fasciitis?
For pain relief, health professionals often prescribe anti-inflammatory drugs that must be taken in conjunction with other therapies.
The drugs usually indicated for the treatment of plantar fasciitis are Betamethasone Dipropionate + Betamethasone Disodium Phosphate , such as Duoflan , Betatrinta and Permese .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Home treatment: how to treat plantar fasciitis naturally?
Natural or homemade treatments are not a substitute for medical advice, but they can be combined in the recovery of the condition. Thus, some measures can be taken at home with the intention of reducing pain and inflammation, such as:
- Ice pack: twice a day, apply an ice pack for 15 minutes on the soles of the feet. In situations where the disease is in its advanced stage, it is recommended to apply up to 5 or 6 times a day;
- Rest: avoid performing activities that aggravate pain;
- Foot massages: for severe pain, such as those that people face in the morning, it is advisable to massage the soles of the feet using a cylinder;
- Footwear and insoles: avoid uncomfortable, hard and unsuitable shoes for the sizes of your feet. Also use orthopedic insoles indicated by the orthopedist or physiotherapist, preferably made to measure.
If plantar fasciitis is not treated properly and the tissue continues to suffer from excessive efforts, the fascia may enter a degeneration process making the pain chronic.
This can favor the appearance of the heel spur, a bony protuberance that grows on the sole of the foot.
If the patient changes his way of walking to minimize pain, it can result in problems with his feet, knees, hips or back.
Plantar fasciitis is an easy disease to prevent, just pay attention to the needs of the feet and avoid applying excessive effort to the soles. Recommendations that can be followed to prevent inflammation are:
- Correct changes in the feet, such as flat feet, cavities or hyperpronation;
- Stretching before and after physical exercises to strengthen the structures of the foot and ankle. The practice of physical activities should be moderate, with professional monitoring, alternating between exercises that require greater effort on the feet with activities that relax them;
- If the patient is overweight, the ideal is to carry out dietary reeducation to reduce a few pounds;
- Avoid walking barefoot or with unprotected shoes and adequate cushioning for the soles of your feet;
- Do not stand still for a long time, especially on high-heeled shoes;
- Activities such as running and jumping should not be performed on hard floors, as it favors impact cushioning.
What does pain in the sole of the foot mean?
The pain in the sole of the foot can be an indication of plantar fasciitis, which is the inflammation of the region. It can happen in a bad way when playing a sport or doing a common activity, such as climbing stairs.
What is the ICD of plantar fasciitis?
In the International Classification of Diseases, plantar fasciitis is listed under the code M72.2 Fibromatosis of the plantar fascia.
What is the best remedy for plantar fasciitis?
First, there must be a medical evaluation. Only then can anti-inflammatory drugs be prescribed. However, it is worth remembering that the treatment goes beyond medication, and must be combined with physical therapy, rest and orthoses, in some cases.
Plantar fasciitis is a common inflammation that causes difficulty in carrying out any activity that involves the feet. Although the treatment is simple, if neglected, it can cause several complications, in addition to the heel spur.
So that your friends and family also know how to prevent the disease, share this article!