Introduction and Overview to Plantar Fasciitis
There is often a lot of confusion surrounding the issue of plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) and whether or not it is the same thing as heel spurs, so let’s take a moment to differentiate between to the two.
Plantar fasciitis literally means this:
Plantar: bottom of the foot
Fascia: connective tissue
So as you can see plantar fasciitis literally means “bottom of the foot connective tissue inflammation.”
Heel Spurs, on the other hand, are found protrusions found on the heel of the foot. They are caused by the tension and inflammation in the fascial tissue and while they may feel like a hard lump they’re actually ‘soft’ growths of calcium. Heel spurs do not cause pain on their own; they are merely indicators that a person may have planter fasciitis.
What Is Plantar Fasciitis?
The best way to describe what plantar fasciitis is to start by explaining what the planter fascia does; fascia is connective tissue that covers the muscle in the soles of our feet. This muscle not only runs through the arch of feet and giving them support, it also connects the heel of our foot to the ball of our foot.
When we are walking and our back leg begins to lift off the ground our plantar fascia is under an incredible amount of tension; in fact, the amount of tension that it’s under is roughly twice our own body weight. And that’s the minimum. Tension will increase if the walker has tight calf muscles, and if they are overweight the percentage of pounds added equals the percentage of increased tension on the plantar fascia. This means that if your body weight increases by 2% then there is a 2% increase in tension in your plantar fascia.
Plantar fasciitis occurs when there is chronic or acute inflammation of the plantar fascia that is often, (but not always) accompanied by heel spurs. This inflammation usually causes a ‘bruised’ feeling in the heel as well as arch pain, though some people do not experience any discomfort at all.
The repetitive nature of activities such as walking can also cause plantar fasciitis to develop as a ‘repetition’ injury, much like tennis elbow or carpel tunnel syndrome. When you increase the odds by having tight calf muscles or gaining weight it becomes clear why plantar fasciitis is such a common affliction. The best way to treat most repetition injuries is with rest, ice, and a gentle stretching of the muscles. While surgery may be an option it is usually viewed as a last resort as it may not only fail to alleviate problem but can actually make the situation worse.
The Primary Symptom of Plantar Fasciitis
Plantar Fasciitis is often called a “heel spur” because the primary symptom is heel pain, especially when it is most acute first thing in the morning. This symptom is so prevalent that if it is not present then the diagnosis must be carefully reviewed.
Pain can also occur when the heel strikes the ground, though it is not actually the foot strike that is causing the discomfort. Nonetheless, some patients may begin walking more toward the front of the foot, which unfortunately makes the problem worse as it places the plantar fascia under much more tension. Because it can take between 12 to 36 hours for pain symptoms to develop it can be very difficult to track the source of the problem. A runner may have a hard time figuring out if it was a change in shoe or a change in terrain that caused problems if both changes were made in the same time period.
Pain severity can range from mildly annoying to downright debilitating, and it can be intermittent or chronic as well, making it somewhat confusing if a patient has never dealt with planter fasciitis before. Plantar fasciitis most often occurs because of how a patient goes about doing things, as opposed to an activity being done. For instance, running with old sneakers can wreak havoc on the plantar fascia, and generally speaking, being overweight or having tight calf muscles can wreak havoc on the feet as well.
Plantar Fasciitis and Children
Active children between the ages of 8 and 13 years old often experience heel pain that seems identical to plantar fasciitis; however, plantar fasciitis is rarely ever seen in people younger than 25 years old. These children likely have Sever’s disease, which occurs when physical activity is combined with a growing heel, which often causes discomfort. Like plantar fasciitis, rest and ice will help reduce the immediate discomfort, and time will do the rest.
Primary Treatments for Plantar Fasciitis
As previously mentioned, surgery is often a last resort when treating plantar fasciitis. Here is a list of the common and effective initial treatments for this type of inflammation:
1. Rest: By reducing the amount and the intensity of your activities you will be reducing the amount of tension on your plantar fascia, which reduces inflammation and gives it more time to heal.
2. Ice: Icing your feet after any activity will help reduce inflammation. Plain ice or a bag of frozen vegetables is great, but make sure you wrap it in a t-shirt or thin towel before you put it against your skin.
3. Stretch: Tight calf muscles are a primary cause of plantar fasciitis so stretching several times every day, (especially first thing in the morning and after sitting for long periods) will help immensely. Simply stand on a stair and raise and lower your heels until the calves are warm and stretched.
4. Tape: Taping is a great way to reduce pain when it is applied properly.
5. Arch Support Inserts: This is an especially useful treatment if you have flat feet.
6. Lose Weight: Carrying excessive weight not adds tension to the plantar fascia directly but it lowers your centre of gravity as well, and this makes the problem much worse. It isn’t easy to lose weight but it is one of the most important improvements you can make for your health and for pain reduction.
Treating Plantar Fasciitis
There is no single cure-all for planter fasciitis, but if you apply the above suggestions it’s likely that you will find relief from your symptoms and that you will eventually reduce or eliminate the cycles of inflammation all together.
And while different people will respond more readily to some treatments and less to others, it’s important to patients and pro-active in your own recovery. It’s important to try as many treatment options as possible and to understand that while some steps will not provide instant relief they will help reduce inflammation and guard against future outbreaks. Your recovery should become part of your daily routine, and while you may not enjoy stretching, icing, taping and resting after activities, and you may see immediate results, it’s important to be patient and to work on getting better every day.
Most likely your discomfort grew over time until you decided to seek treatment, and most likely your pain will be reduced over time as well, and not immediately as we all wish. Setbacks will occur and you may feel frustrated on occasion but it’s important that you stick with your routine, not just to alleviate pain but to reduce the chances of your plantar fasciitis getting worse or returning in the future.
The Lifestyle Factor
Lifestyle choices contribute heavily to the development of plantar fasciitis in most patients, whether it’s poor choice in footwear, inactivity, excessive running, etc. Because these things are under a patients control it is in their best interest to make the necessary changes.
One factor that may be difficult to change is the amount of sitting or standing that you do; having a desk job often creates muscles tightness and imbalances, so special care must be taken to keep the body supple. Tight calf muscles are especially detrimental to healthy feet. Be sure to stand and walk as often as possible, and try to stretch on a daily basis; this should help alleviate some of the problem.
Plantar fasciitis and “heel spur syndrome” are not the same thing although they are very intimately linked; and while you may have planter fasciitis without heel spurs it’s unlikely that you will have heel spurs without planter fasciitis. Regardless, hopefully this introduction and overview to planter fasciitis has provided enough information to help you deal with heel pain.
And just a reminder; although heel spurs appear to be protruding, spike shaped they are actually flat, shelf-like deposits, so while it’s easy to suppose that these growths cause pain by poking into surrounding tissues this simply isn’t the case. Many people have heel spurs and do not even know because there is no pain.
A heel spur is usually present when plantar fasciitis is present, and it is this inflammation that causes so much discomfort. In the majority of cases it is both difficult and unnecessary to distinguish between these conditions however, since they are so often seen together and are treated as one and the same. This is also why doctors will often refer to heel spurs and planter fasciitis interchangeably. In fact, many doctors prefer to use the term ‘heel spurs’ with their clients because they can point to something tangible on the x-ray—not to mention that it is easier to pronounce than ‘plantar fasciitis.’
Regardless of whether you have one of these conditions or both, it’s very important that you make the recommended lifestyle changes in order to become—and remain—pain free.