Plantar fasciitis is one of those conditions that you don’t usually hear much about until you or someone you know develops it themselves. It’s very painful and debilitating because the pain in your feet makes it nearly impossible to get around normally and handle the daily activities of life.
Since most patients are unfamiliar with it, they are likely lacking the vital information they need to seek the proper treatment.
Simply put, plantar fasciitis is inflammation of the muscle bodies on the bottom of the foot, so imagine that when you walk, your entire weight is stepping down onto this bed of muscle bodies and stretches out and contracts for you to walk. There is a significant opportunity for any sort of inflammation or injury in this area to create compounded problems.
When a patient has experienced plantar fasciitis pain and learns how to handle it and educate themselves on their condition, they are more likely to seek and apply effective treatment for the pain.
While patients may not fully grasp the original cause of their pain or have the ability to mitigate the risk factors associated with plantar fasciitis, the fight for manageable pain levels begins with a patient’s willingness to be proactive. Armed with the appropriate knowledge, patients can tackle the condition with alacrity and hope for a future of improved quality of life.
Understanding Plantar Fasciitis
Plantar fasciitis is a painful foot condition that accounts for over 600,000 visits to primary and specialist care clinics in America, making it one of the leading causes of foot and heel pain. Also known as plantar heel pain (PHP), this condition exhibits itself on the bottom of the foot between the arch and the heel in the cords of tissue known as the fascia. This part of your foot is intended to hold the weight of your body and flex to absorb the shock from stepping and standing.
You can think of the fascia as the built-in bridge that connects your heel to your toes and facilitates movement and communication along the bottom of your foot.
When it comes to understanding the nature and causes of plantar fasciitis, it is important to start by clarifying that, just like most other conditions that have the suffix -itis in their name, this is an inflammatory condition.
It arises when the fascia becomes inflamed, irritated, or damaged, and can lead to severe pain, changes in the gait, and reduced foot mobility. Although most plantar fasciitis cases resolve by themselves with lifestyle modifications within a year, this condition can lead to complications such as structural changes in the foot and the degeneration of the connective tissue in the fascia (plantar fasciopathy).
Plantar fasciitis can affect anyone at any age, but it often arises as a consequence of excessive stress and tension on the fascia, which can be caused by repeated forceful movements (i.e.: running), a sedentary lifestyle, obesity, improper footwear, or aging.
Let’s look at the symptoms and risk factors for plantar fasciitis in more detail below.
Symptoms Of Plantar Fasciitis Pain
Since plantar fasciitis develops gradually over time, the first symptom that you may notice is mild discomfort. However, as inflammation worsens, the painful sensations may become chronic, stabbing, or burning pain that spreads from the arch of the foot to the top of the foot and heel.
Most patients with plantar fasciitis will notice that the pain will manifest in the morning when they first stand and have been walking or standing for long periods.
Besides pain, other symptoms of plantar fasciitis include the following:
- Stiffness and swelling: The build-up of fluids and increased blood flow to the damaged area are normal aspects of the body’s inflammatory response. However, in the case of inflammatory conditions, the swelling is sustained over long periods of time. In turn, swelling around the foot and ankle area can lead to stiffness or the inability to move your foot properly.
- Tight Achilles tendon: If you have plantar fasciitis, you may notice sensations of tightness in the Achilles tendon, which attaches to the plantar fascia. An inflamed fascia will cause you to change your foot mechanics and gait to avoid pain, which may put excessive stress on the Achilles tendon. When this happens, you may start suffering from a tight Achilles tendon and, in severe cases, from a secondary Achilles tendinitis (inflammation of the Achilles tendon).
- Reduced foot mobility: If your foot’s fascia is tight, inflamed, or stiff, you may have trouble moving your foot properly. Movements such as lifting your toes or climbing stairs can become difficult or painful.
If left unaddressed, plantar fasciitis may also lead to a cascade of complications. Firstly, sustained or chronic inflammation may cause permanent damage to the connective tissue in the fascia. Additionally, changes in the way you walk to compensate for the pain can cause you to develop foot deformities such as heel spurs.
Physicians Explain The Causes Of Plantar Fasciitis
The cause of this pain has been attributed to inactivity, as well as excess activity– another reason why plantar fasciitis is one of the least understood conditions of pain.
Many physicians, such as Dr. Lindsey Luffy, explain in the most basic terms that, “[p]lantar fasciitis is a degeneration of the plantar fascia as a result of repetitive microtears of the fascia that lead to an inflammatory reaction, and is not a primary inflammatory process that most believe it to be” (2018).
However, Dr. Luffy goes on to state that, “[t]he cause of plantar fasciitis is unknown but is believed to be multifactorial, with abnormal biomechanics and delayed healing as likely contributors”. The “abnormal biomechanics” Dr. Luffy mentions specifically refers to the use of the fascia that is likely to lead to wearing down the cords of tissue.
For example, if a patient suffers from chronic gout or has experienced ankle injuries that cause them to walk in an abnormal way, the likelihood of developing plantar fasciitis increases. Along with “abnormal biomechanics”, Dr. Lindsey refers to “delayed healing” which is a cause of plantar fasciitis on which patients can likely have a direct impact.
As mentioned before, when patients educate themselves on the condition of plantar fasciitis, they are more likely to be proactive and seek treatment early on. When intervention is early and intentional, the progression of the condition is greatly decreased.
As was mentioned previously, patients who experience pathogenesis of plantar fasciitis have likely seen it develop due to abnormal biomechanics that are themselves a result of another painful condition or injury.
Patients suffering from these conditions and subsequent plantar fasciitis will often ask themselves how much their feet can handle before experiencing pain and whether it would be better to stay off their feet altogether.
Unfortunately, those who stay off their feet to avoid the pain know that the moment they stand, the pain will come searing back. Even when patients understand the cause or development of their plantar fasciitis, they often feel frustrated at their inability to move and be physically proactive.
Over time, the demands of daily life will necessitate the use of a patient’s feet and the constant stretching of the fascia will further inflame and irritate the condition of plantar fasciitis. So, what are patients with developed plantar fasciitis to do?
Managing Risks Associated With Plantar Fasciitis: Awareness Is The Key
The solution to addressing developed plantar fasciitis goes back to education. With further education in mind, the risk factors must be explained in order for patients to seek effective treatment.
Once the risk factors for plantar fasciitis have been assessed, it is likely that patients will find they can reduce the likelihood of experiencing plantar fasciitis pain by managing their risk factors where possible.
Below, we’ll look at the main risk factors for plantar fasciitis and how to manage them.
First Risk: Age
Because plantar fasciitis should be understood as a degenerative tissue condition, the most common risk factor, as is common with most conditions related to pain, is age.
Age is primarily a risk factor for plantar fasciitis because the fascia’s nature wears down over time.
A lifetime of walking and performing daily activities can cause the fascia to wear and tear, become less elastic, and lose its ability to withstand stress or absorb shock. Additionally, as we age, our feet become wider due to repeated stress that may flatten some of the foot’s structures. This can change how the weight is distributed during movement and can put the fascia under excessive stress.
The likelihood of plantar fasciitis symptoms cropping up in patients is in direct correlation with the age of those patients–the age being around fifty. However, some patients claim to have felt the pain of plantar fasciitis decrease as they age. This is not due to the condition miraculously going away over time but the reduction of physical activity and therefore, irritation of the plantar fascia is reduced.
While you can’t stop the effects of aging on your body, you can manage the risk of suffering from plantar fasciitis through certain lifestyle choices, such as massaging and stretching your feet, maintaining a healthy weight, or choosing supportive shoes.
Second Risk: Excess Weight
As mentioned earlier, excess weight can also cause unnecessary strain on the fascia. When this is compounded with the wearing down that occurs with age, a patient can begin to understand the delicate nature and necessity for care of their feet.
Fortunately, and unlike the age of a patient, weight is one of the manageable risk factors that will influence the pain from plantar fasciitis.
Although working with a specialized nutritionist should always be your first port of call, eating a nutritious and balanced diet, maintaining a healthy weight, and exercising regularly can help you avoid the complications associated with a high BMI or obesity.
Third Risk: Harmful Exercises
While patients claim to have reduced plantar fasciitis pain when activity is decreased, one of the more surprising risk factors is exercise. In order to appreciate and fully understand the impact of exercise on plantar fasciitis, we must first qualify which types of exercise contribute to the pain associated with the condition.
Qualifying the type of harmful exercise will reduce the likelihood of patients exercising in a way that might exacerbate their condition. At the same time, patients should be aware that exercise that does not worsen their condition could lead to weight loss and less strain on their plantar fascia.
While many who hear about plantar fasciitis might assume it is characteristic of an older population, patients who experience the pain are often young dancers or distance runners who spend long hours placing strain on their feet. Even occupations that require patients to remain on their feet for long periods of time may also experience the pain associated with plantar fasciitis.
Activities that involve frequent jumping or walking on uneven surfaces can lead to plantar fasciitis. You may be at greater risk of developing this condition if you practice sports such as football, soccer, or trail running. Some occupations may also involve movements that lead to the inflammation of the fascia. These include professions that require you to be on your feet all day long.
If you are an athlete, working with a personal trainer or physiotherapist can help you better understand how to improve your form to avoid injuries. On the other hand, if the condition is caused by factors related to your job or hobbies, an occupational therapist will be able to help you make positive changes in your life to safeguard your foot health.
Patients who learn and understand the risk factors for plantar fasciitis will understand the signals from their bodies and learn to manage their pain, although the condition will worsen with time.
Conventional Treatment Options For Plantar Fasciitis
As we have seen above, plantar fasciitis is a degenerative condition that worsens gradually over time. While it may be asymptomatic at first, inflammation of the fascia can lead to chronic or acute pain, and impair most of your daily activities.
Eventually, patients with plantar fasciitis pain will require treatment to manage the pain. The task for those seeking to manage their pain without surgery is to find a treatment that works and lasts without side effects.
Besides physical therapy, massages, rest, ice compresses, and immobilization, patients are often recommended one of the therapies below. Understanding the side effects of these lines of treatment is essential to understand the risks involved and choosing a pain management program that works for your needs.
Let’s look at the most common treatment options for plantar fasciitis below.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin are often recommended by doctors to alleviate painful sensations. While these medications are easily accessible over-the-counter and may relieve pain in the short term, they cannot be considered valid long-term solutions.
Patients with plantar fasciitis may experience pain for a year or longer. Taking these medications for such long periods can expose you to severe side effects, including gastrointestinal ulcers, kidney failure, increased risk of heart attack or stroke, or dependency.
Iontophoresis is a medical procedure that involves delivering ionic (soluble) medications into the body through the skin. Iontophoresis is performed by applying mild electrical pulses to the painful area.
In the case of plantar fasciitis, a 1997 study showed that iontophoresis of 0.4% dexamethasone may be effective in reducing the symptoms of an inflamed fascia when other more conservative methods haven’t worked. New clinical trials are also attempting to determine whether iontophoresis is a valid alternative to ultrasound therapy in the treatment of plantar fasciitis.
Iontophoresis can cause mild side effects, such as minor electric shock or temporary tingling sensations. However, this treatment option isn’t recommended for patients who are pregnant, epileptic, or wearing devices such as pacemakers.
While there are treatments available for plantar fasciitis, there is one treatment in particular that patients should be made aware of– and not necessarily for its positive effects.
In an extensive study untangling the puzzle of plantar fasciitis, Dr. Daniel Latt of the American Orthopaedic Foot & Ankle Society concludes that “[t]he therapeutic benefit of corticosteroids is dependent on their anti-inflammatory properties, which provide significant pain reduction.
However, they also act to inhibit fibroblast proliferation and ground substance protein expression. These effects can produce atrophy of the plantar fascia and plantar fat pad and lead to complete plantar fascia rupture, both of which are difficult to treat” (2020).
As was mentioned previously, plantar fasciitis is not only a condition of inflammation but degeneration as the tissues of the plantar fascia wear down. Dr. Latt not only concludes that corticosteroid injections would do little to solve the problem of plantar fasciitis but might actually make the condition worse– effectively atrophying, tearing down, and rupturing the plantar fascia.
Dr. Latt continues to embolden his claim by stating that a “. . . number of studies have demonstrated the association between steroid injections and plantar fascia rupture. In summary, steroid injections may provide temporary symptomatic relief but are associated with an increased risk of developing persistent pain, local tissue atrophy, or plantar fascia rupture.
Thus, if they are used it should be with caution and patients should be advised of the risks and benefits before injection”. Dr. Latt, without dismissing CSIs completely, properly provides the context and risk factors associated with their use in plantar fasciitis.
One of the biggest determinations patients need to make when it comes to treating plantar fasciitis pain is if the treatment is safe. The second preliminary decision that helps patients determine their proper course of treatment is whether the treatment is effective. Luckily, better options are becoming available in the medical field that may help.
Plantar Fasciitis Pain Treatment And Our Neurofunctional Pain Management Approach
Neuragenex is pioneering Neurofunctional Pain Management and focuses on three core components for patient care to ensure that treatments are safe, effective, and covered by Medicare and commercial insurance.
Neurofunctional Pain Management may be the future of chronic pain management, but most people wouldn’t be able to participate if those three elements were safe, effective, and reimbursed. Patients can be sure that their condition will be met with a targeted and professional approach that works to treat the pain and maintain the quality-of-life patients expect and deserve.
Neurofunctional Pain Management is a combination of disciplines that work together to produce effective pain relief.
Neuralgesia And IV Therapy
Neuragenex has a proprietary treatment protocol called Neuralgesia and is a combination of high pulse electrical stimulation that relieves pain in the affected area and specialized hydration therapy to balance nutritional deficiencies in patients suffering from chronic pain conditions.
Neuralgesia utilized a high-pulse electrical stimulation treatment called electroanalgesia that has been around for decades as an approved treatment for nerve pain. However, combining that treatment with specialized hydration makes this even more effective for a patient, relieving their pain, restoring their health as much as possible, and magnifying their quality of life.
As a part of Neurofunctional Pain Management, patients will not only be treated with high pulse electrical stimulation and specialized hydration and nutritional deficiency replenishment, but they will also engage in a thorough patient education program throughout the course of their treatment program.
This education process is critical to patients changing their lives, bringing them greater success in enduring pain relief.
A typical patient that goes through a treatment program with Neuragenex has an extended period in which the pain relief will endure after the treatment program is completed. Imagine if you could get out of pain, then that pain relief motivated you to get back into a better state of health, and that motivated you to engage in a higher quality of life altogether.
Our Goal At Neuragenex Is To Help Patients Like You
We aim to see and celebrate the improved quality of life patients have through Neurofunctional Pain Management and the specific protocols we’ve developed here at Neuragenex. As patients understand their condition, participate in effective treatment, and maintain a positive outlook on their condition, they can experience that magnified quality of life that drives our passion for this work.
At Neuragenex, we aim to relieve pain, restore health, and magnify the quality of life without drugs, surgeries, or invasive procedures. Our vision is to be the first thought, first choice, and first step in the journey of chronic pain relief.