Do you often feel strong stitches in your heels? Do these pains appear early in the morning, when you get up, when walking or after practicing some physical activity?
These are some of the common symptoms of a condition known as plantar fasciitis arch pain. This condition manifests itself as pain in the heel, which occurs when there are pressure and strain.
What is plantar fasciitis arch pain?
Plantar fasciitis is an inflammation that affects the plantar fascia, a membrane of tissue that lines the musculature of the sole of the foot.
The fascia is responsible for keeping the curvature of the feet firm, as it has the ability to cushion and distribute the impact.
The exact cause of this pathology is still unknown. But in most cases, it is due to the excessive stretching of the fascia caused by repetitive movements.
The most characteristic symptom of plantar fasciitis is the very sharp pain under the foot close to the heel.
Which can appear with greater intensity in the morning, when climbing stairs, or even after a period of rest. In addition to pain, other symptoms may appear, such as swelling and redness.
Without proper treatment, plantar fasciitis arch pain can become chronic and cause injuries to the knees, hips, and spine.
Note that plantar fasciitis is the most frequent cause of heel pain, affecting between 3.6 and 7.0% of the population. Its peak incidence occurs between 40 and 70 years of age, affecting females and males equally.
Ignoring plantar fasciitis in its acute phase can lead to chronic pain and more severe problems.
Causes of plantar fasciitis arch pain
Why does a person develop plantar fasciitis arch pain? There are several reasons. Here are some of the possible answers:
- Obesity: This is one of the main causes of plantar fasciitis. When an individual’s weight increases, the feet become overloaded because they support the human body.
- Your type of foot: If you have a flat or hollow foot. you will be more likely to develop this kind of pathology.
If you wear shoes that are too worn out, have a heel that is too soft, too or not stiff enough, or that provide poor support to your arch, you are at greater risk.
- Legs: If you have one leg longer than the other, or if you have poor leg rotation, you are at greater risk.
- Physical exercise: A lack of stretch during training can also cause plantar fasciitis. Sportsmen doing running long walks, or skipping are also more vulnerable to this type of pathology.
- Age: Aging makes your plantar fascia more rigid, especially in individuals aged 40-70 years. This can, therefore, create micro-tears.
Most patients describe that the symptoms of plantar fasciitis are load-dependent and begin gradually. The pain in the heel usually recurs over a long period of time, i.e. weeks or even months.
However, it disappears when you are resting. But even in the morning after getting up, many sufferers are plagued by pain in the heel area. This symptom disappears again after a short walk.
Even when doing sport or in everyday life, many patients initially have no symptoms. Towards the end of the workout or when the workday is almost over, the pain comes back. They start in the heel area and can radiate into the entire sole of the foot.
If you don’t do anything about your plantar fasciitis. In extreme cases, the inflammation can become chronic, and you can no longer walk without pain. Below we have summarized the symptoms again in brief:
- Gradual pain in the heels that get worse over time.
- Swelling and redness
- Heel pain after getting up, but then goes away.
- Extreme pain during exercises, such as jumping.
See a doctor when plantar fasciitis arch pain
If the pain due to plantar fasciitis is accompanied by tingling or numbness in your feet and doesn’t get better. after two weeks of self-care at home, or it’s causing you difficulty in carrying out your daily activities.
Also, see a doctor immediately if you have diabetes accompanied by symptoms of plantar fasciitis. This is because, in diabetics, foot disorders can be a serious condition.
Examinations and diagnosis of plantar fasciitis arch pain
If you suspect you have plantar fasciitis, you can see a general practitioner or an orthopedic specialist.
Typical questions the doctor may ask during the anamnesis interview could be:
- Have you had an acute foot injury?
- Does it hurt under the heel when put under stress?
When does the pain occur? In which movements?
- When is the pain most severe? When do they subside?
- Where is the pain radiating to?
During the examination, most patients usually report tenderness under the heel at the attachment point of the fascia. A rupture would show a bruise on the sole of the foot with tenderness to pressure.
If the symptoms are acute, it is probably a strain or a tear of the plantar tendon. If this is the case, you have to stop any form of exercise you are doing immediately.
Sometimes swelling or bruise can also indicate other injuries such as fractures, muscle injuries, or a tear.
Diagnosis of plantar fasciitis
The diagnosis of plantar fasciitis is made by the orthopedist based on clinical history. In some cases, using some tests or Complementary Diagnostic and Therapeutic Means (MCDT), namely:
- Radiography (X-ray) of the foot. – It can be useful to confirm plantar fasciitis diagnosis.
- Magnetic resonance imaging (MRI) – It is rarely used in diagnosis.
Bone scintigraphy – It is an examination that helps to quantify inflammation. It can be performed to exclude other pathologies.
- Analytical study – Although not used routinely, it can be useful to exclude other pathologies.
- Electromyography – Electromyography can be used to exclude nerve compressions.
Treatment of plantar fasciitis arch pain
The treatment for plantar fasciitis should be instituted by the orthopedic doctor after diagnosis.
There are several treatment options that must be individually adapted to the patient in question.
It should be noted that it is very important not to give up treatments to avoid future complications, such as pain in the heel whenever you are walking.
The prescription of Non-Steroidal Anti-Inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, usually in tablets or anti-inflammatory ointment, allows to relieve pain and reduce inflammation of the plantar fascia.
Remember that you must always take this medication as indicated in the medical prescription.
Drug treatment may also, in the most severe cases, include infiltration of corticosteroids into the foot (dexamethasone, methylprednisolone, or beclomethasone + lidocaine).
The orthopedic insole allows the load in the body to be distributed, thus alleviate pain.
Use of comfortable, functional shoes developed in order to allow a better distribution of the weight when walking can be a good option to be used in the most acute phases, giving you relief from the pain.
Physical therapy through exercises specific to stretching the plantar fascia is a good option in the treatment.
Physiotherapeutic treatment should preferably be carried out with exercises that allow the stretching of the plantar fascia and gastrocnemius.
Extracorporeal Shock wave therapy (ESWT)
In situations of chronic heel pain that exceeds six months, shockwave therapy can be recommended. In extracorporeal shock wave therapy, ultrasound shock waves are brought into the injured region via the skin.
Because of its success in improving movement and reducing pain, the method has become increasingly important.
However, since the treatment costs are very high, only chronic cases and cases that do not respond to other conservative measures are initially treated.
Changes in lifestyle
In the case of obesity, you must lose weight in order to reduce the pressure on the joint. However, if you feel pain in the heels, you should avoid any form of exercise.
In addition, it is advisable to have a long rest and avoid contact with the ground.
If there is no pain, a gradual return to physical activity can be resumed after 4 to 6 weeks of rest. In the acute phase, you should not force yourself to walk. But after the acute phase, walking is beneficial.
Homemade tips to relieve the pain of plantar fasciitis
As a home or natural treatment, you can do stretching exercises. Using a tennis ball and towel to relieve pain can be performed.
Roll your foot over the ball and force the dorsiflexion (pull your foot up) with the help of the towel.
To relieve inflammation, it can be useful to walk your foot over a bottle of frozen water for 10 to 15 minutes.
In the acute phase, the application of ice (cold) two to three times a day directly on the heel for 5 to 10 minutes also helps to relieve pain.
However, note that the application of ice in the non-acute phases does not bring relief, in which case you should apply heat (hot water) that helps in relaxing the muscles and fascia.
You should wear shoes with soles that allow you to cushion shocks. As a rule, wear malleable soles that allow better absorption of impacts with the ground.
That is, you should avoid wearing shoes or sneakers that have a rigid sole. You should avoid walking barefoot, especially in the morning.
In case the measures mentioned above fail, which is rare, surgical treatment should be considered.
Surgery for plantar fasciitis arch pain
The operation in the plantar fasciitis should be considered only in case of failure in conservative treatment. Which occurs in about 5% of patients.
The surgery, called a plantar fasciotomy, consists of releasing 30 to 50% of the fibers from the fascia.
The estimated success rate is between 70 and 80%, being higher in situations in which gastrocnemius release is associated.
This technique is indicated in situations of chronic pain (over nine months) refractory to conservative treatment.
Open surgery or arthroscopic surgery can be performed with equal effectiveness, allowing you to recover faster.
A lower leg splint needs to be worn for about two days after the operation. After that, it is important to be careful when walking in the first few days, whereby special insoles should be used.
Physiotherapy with a specific foot muscle strengthening and stretching program is also required.
Plantar fasciitis is a disease that evolves in most cases. About 90% of patients improve significantly in the first two months of treatment.
However, it may take some time for the symptoms to disappear permanently, in some cases up to a year.
When choosing a shoe, it is important to keep in mind two factors: cushioning and comfort. The sole should not be too rigid, as it needs to allow the mobility of the feet during the walk.
In the case of the hollow foot, the insole increases the contact area of the foot, redistributing the pressures and improving the cushioning.
On the flat foot, the insole offers correct support to the arch and removes the load from the plantar fascia.