Plantar fasciitis - A Simple Patient Guide by Dr Vivek Baliga, Bangalore

Plantar Fasciitis - Why
Do My Feet Hurt?
Dr Vivek Baliga B
Consultant, Internal Medicine, Bangalore
http://heartsense.in

Plantar Fasciitis - Why Do My Feet Hurt?
Plantar fasciitis is a term you might have heard of. But you probably never
experienced the condition…..until now.
Have you ever woken up in the morning and found it hard to walk to the
bathroom because your feet hurt so much?
How about getting up from your o ce chair and walking to the water
cooler being a painful experience?
If you have ever su ered from these, then you probably have plantar
fasciitis (pronounced ‘fash-eee-eye-tis).
Today I will talk about why this condition is making your feet painful and
how you can manage it with some simple steps.
Plantar fasciitis is one of the most recognised and common causes of pain
in the feet.
Speci cally, a ected people have pain in their heel. The pain is because of
inflammation of tissue under the foot called plantar fascia.
The Plantar Fascia
The plantar fascia is a thick band of tissue that is present at the base of the
foot.
It is attached to the heel bone and then fans out and attaches to the toes. A
description of this is given in the image below.
Plantar Fasciitis - Why Do My Feet Hurt? Causes, Symptoms & Exercises.

The plantar ‘aponeurosis’ refers to the fascia. It extends from the heel to
the toes and provides support. Image courtesy Wikimedia Commons.
The primary role of this fascia is to provide support to the foot. It also acts
like a ‘shock absorber’. when we place our feet on the ground.

When too much strain is placed on the fascia, it can result in small tears in
the tissue. This leads to tissue damage and inflammation.
When the plantar fascia becomes red and in amed, it can lead to pain. This
is called plantar fasciitis.
Other than excessive strain, there are no clear causes of plantar fasciitis.
However, there are certain risk factors that increase the chance of this
affecting you.
RISK FACTORS FOR PLANTAR FASCIITIS
1. Age
Most common between 40 to 60 years, though younger individuals can be
affected.
2. Exercise
If you take up ‘impact’ exercises such as running etc, then this can place
some strain on the fascia. Sports that involve jumping can also lead to
pain.
3. Faulty arch
When you place your foot on the ground and look at the inner aspect of it,
you will notice an arch. If this is either too high or if you have at feet, you
risk injury to the fascia and developing plantar fasciitis.
4. Standing for long hours

If you are constantly on your feet at work or at home, then you risk injury
and pain. Teachers are particularly prone.
5. Being overweight
For every extra kilogram that you weigh, you place an additional 4 kilos of
weight on your lower limbs. Excessive weight and obesity does not spare
your feet, and you will likely suffer from pain and inflammation.
Stabbing pain is the most common description of pain. It usually a ects
the heel, though some people find that it affects the entire foot.
The pain is worse early in the morning after waking up and placing the feet
on the ground.
After a night’s rest, the plantar fascia that is in amed can become quite
taut and tensed. When you place your foot on the ground, it stretches this
tendon and can lead to pain.
As you continue to walk, the fascia begins to relax and this reduces the
pain.
In other words, pain from plantar fasciitis reduces as you exercise or walk.
It worsens after resting for a while.
For example, say you woke up in the morning with pain in the feet. You
walk a few steps, do your household chores and then walk to your office.
You sit at your o ce desk and after an hour or so decide to drink a glass of
water. When you walk towards the water cooler, your feet will hurt again.

Once again, they get better after you walk a while.
Some people may experience pain after they finish exercise.
Besides the pain, there are no other symptoms of plantar fasciitis.
A diagnosis can be con dently made by the physician from clinical history
alone. There are no specific tests that will confirm the diagnosis.
Sometimes, an x-ray of the foot may be performed.This might show the
presence of a ‘calcaneal spur’ – a thickened part of the plantar fascia
attached to the heel bone.
In rare cases, an MRI scan may be performed.
It is unwise to leave the pain untreated. This is because it can lead to a
change in the posture adopted when walking, which in turn can a ect the
hip and knee joints.
The best way to treat plantar fasciitis is to avoid excessive foot strain.
But that can be hard.
Instead, you could try certain stretching exercises that will loosen up the
tissue and reduce the pain. Painkillers may be prescribed.
There are also certain devices called ‘orthotics’ that can help reduce strain
and pain.
Let’s look at some home remedies first.

Home Remedies For Plantar Fasciitis
Before we dive into di erent treatment options, there are some simple
home remedies you could try first.
Make sure you avoid excessive strain to the plantar fascia. Wear
comfortable and soft slippers at home and when venturing outside.
If you are an athlete, you may require insoles to maintain the arch of your
foot when exercising. You may need to make sure you change your
footwear now and again.
For runners with plantar fasciitis, you would want to consider changing
your shoes after you have completed around 500 to 600 km of total
running in them. Wearing worn out shoes can worsen the problem.

After you have completed your exercise routine, apply ice to the foot. This
will reduce the acute in ammation and reduce the chances of pain later
on.
Ensure you maintain a healthy body weight. The lighter you are, the lesser
the stress on the fascia.
If you are having trouble, you could try wearing insoles for your footwear.
These can help with the pain to some extent.
You could check out some insoles by clicking here.
Finally, do some of the stretches I have described in the next section.

Stretching Exercises
You could perform some of the these simple exercises to stretch the
plantar fascia to loosen it up.
1. Hamstring Stretch

2. Calf Stretch

3.Plantar Fascia Stretch

4. Tibialis Anterior Stretch

Physiotherapy
If the above home remedies do no work, you could consider
physiotherapy.
I spoke with Dr Gladson Johnson of Attitude Prime in Bangalore, who had
the following to say –
”The very common reasons behind plantar fasciitis are quite simple
– improper cool down stretching and irregular indulgence in strengthening
exercises”.
This leads to tightening of the hamstring muscles, which in turn leads to
stiffness of the calves and the plantar fascia.
Night Splints
These are supports for the foot that are worn at night. They keep the
plantar fascia stretched through the night, making it soft and less taut in
the early hours of the morning.
If the above treatments fail, there may be other ways to manage plantar
fasciitis.
Steroid injections may be given, but these should not be given repeatedly
as they can weaken the fascia.

High frequency ultrasound wave therapy, also called extracorporeal shock
wave treatment, may be tried. This could reduce in ammation and pain,
but the technique is still in it’s early stages.
Finally, if all else fails, surgical release of the fascia may be performed.
Here the fascia is disconnected from the heel bone completely. However, it
might weaken the arch support of the foot.
Plantar fasciitis is a painful problem that can a ect quality of life. Some
people do not get the relief they expect despite trying painkillers. Some of
the measures described above will help.
For more information and health tips, visit http://heartsense.in

Plantar fasciitis - A Simple Patient Guide by Dr Vivek Baliga, Bangalore

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Plantar fasciitis - A Simple Patient Guide by Dr Vivek Baliga, Bangalore