Living With Chronic Pain

Ow, My Aching Foot!

Plantar fasciitis (PLAN-tur fash-ee-eye-tis) is one of the most common causes of heel and arch pain. It involves inflammation of a thick band of tissue (the plantar fascia) that runs across the bottom of the foot and connects the heel bone to the toes.

It commonly causes a stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting.

Causes

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Too much pressure on the plantar fascia can damage or tear the tissues, causing heel pain. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn’t clear.

Heel Spurs 

Many people with plantar fasciitis have heel spurs. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Spurs at the sole of the foot (plantar area) can sometimes be associated with plantar inflammation because the spur can inflame the plantar fascia. Chronic inflammation left untreated can also lead to feel spurs.

X-ray of heel spur
Heel spurs

Risk factors

Though plantar fasciitis can arise without an obvious cause, factors that can increase your risk of developing plantar fasciitis include:

  • Age. Plantar fasciitis has an increased incidence between ages of 40 and 60, affecting more women the men. But it affects all ages. My daughter has had it since her early twenties due to her athletic activities and working on her feet for hours.
  • Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue, such as long-distance running, ballistic jumping activities, ballet dancing and aerobic dance can contribute to an earlier onset of plantar fasciitis.
  • Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you’re standing and put added stress on the plantar fascia.
  • Obesity. Excess pounds put extra stress on your plantar fascia. Studies show people who are overweight are 70% more likely to develop plantar fasciitis than people of a healthy weight. These individuals often take shorter steps, which places more pressure on the heel.
  • Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
  • Inadequate shoe support. Wearing shoes such as flip flops increase risk of plantar fasciitis.
  • Tighter calf muscles. This makes it difficult to flex your foot and bring your toes up toward your shin
  • New or increased activity. After my foot surgery, I was forced to heel walk for months. I’ve suffered from plantar fasciitis in that foot ever since.
  • A shorter leg. Many people have one leg that is just a bit shorter than the other. The slight unevenness of gait and posture places more pressure and stress on the longer limb, which can irritate and eventually inflame the tissues of the foot.
  • Pregnant women. When standing, they typically shift their weight to find a more comfortable position. This can result in flat feet, which in turn can cause plantar fasciitis. Other factors involved in the development of plantar fasciitis are almost always present in pregnant women, such as weight gain, water retention, and uncommon pressure on unusual points of the feet.

Symptoms

A stabbing pain:This occurs in the bottom of your foot near the heel and us is usually worse with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting.

Develops in stages: It may begin with slight discomfort in the foot, especially noticeable when walking or running. 

Unilateral foot pain: This occurs in more than 75 percent of cases of plantar fasciitis. It could be because most people unconsciously favor one leg or foot over the other. The foot with which an individual begins walking is usually the foot affected by plantar fasciitis. However, the pain can sometimes move from one foot to the other.


Heel Spurs do not cause plantar fasciitis 

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.


Complications:

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. Changing the way you walk to minimize plantar fasciitis pain might lead to arch destabilization, loss of arch height, and foot, knee, hip or back problems.

For most, plantar fasciitis will usually resolves in time. Unfortunately for some, like me and my daughter, plantar fasciitis had become a chronic condition. Symptoms may improve and then appear again, or the pain may remain consistent for a year or longer. Studies suggest that people who have previously had an episode are more likely to have it again. Next week, I’ll discuss treatment options and exercises that can be done to help alleviate the effects of plantar fasciitis.



Sources:

-aafp.org/afp

-mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846

-ncbi.nlm.nih.gov/pmc/articles/PMC5844527/

-orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_foot-and-ankle.pdf

-medicalnewstoday.com/articles/324353.php

-facty.com/conditions/plantar-fasciitis/10-symptoms-of-plantar-fasciitis/9/

-orthoinfo.aaos.org/en/diseases

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