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What is plantar fasciitis?

Plantar fasciitis

Plantar fasciitis is a disorder that causes pain in the heel and in the lower part of the foot. It’s important to wear the best shoe for plantars fasciitis to recover.The pain is usually more severe with the first steps of the day or after a rest period. 

Pain also occurs frequently when you bend your foot and toes toward the shin and may be aggravated by a tight Achilles tendon. The condition usually appears slowly. In approximately one-third of people, both legs are affected.

Plantar fasciitis symptoms

The causes of plantar fasciitis are not entirely clear. Risk factors include excessive use, such as for prolonged periods, an increase in exercise, and obesity. It is also associated with the internal balance of the foot and a lifestyle that involves little exercise. 

Although heel spurs are often found, it is unclear whether they have a role in causing the disease. Plantar fasciitis is a disorder of the site of insertion of the ligament in the bone characterized by micro tears, collagen rupture, and scarring. Since inflammation plays a minor role, a review proposed that the name of plantar fasciosis be changed. The diagnosis is usually based on signs and symptoms, and ultrasound is sometimes used to help.

 Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis. Most cases of plantar fasciitis resolve over time and conservative methods of treatment. Usually, during the first weeks, people are advised to rest, change their activities, take painkillers, and stretch. If this is not enough, physical therapy, orthotics, splints, or steroid injections may be options. If other measures do not work, extracorporeal shock wave therapy or surgery can be attempted.

Between 4% and 7% of people have heel pain at any given time, and approximately 80% of these cases are due to plantar fasciitis. Approximately 10% of people have a disorder at some time in their life. It becomes more common with age. It is not clear if one sex is more affected than the other.

The cause of plantar fasciitis is poorly understood and is believed to have several contributing factors probably. The plantar fascia is a thick fibrous band of connective tissue that originates in the medial tubercle and the anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting into the base of the toes and supports the arch of the foot.

Originally, it was believed that plantar fasciitis was an inflammatory condition of the plantar fascia. However, in the last decade, studies have observed microscopic anatomical changes that indicate that plantar fasciitis is actually due to a non-inflammatory structural decomposition of the plantar fascia instead of an inflammatory process.

Due to this change in thinking about the underlying mechanisms in plantar fasciitis, many in the academic community have stated that the condition should be renamed plantar fasciosis. It is believed that the structural failure of the plantar fascia is the result of repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, calcium deposits in connective tissue, and disorganized collagen fibers.

It is believed that abnormalities in the normal mechanical movement of the plantar fascia during rest and walking (known as the Windlass mechanism) contribute to the development of plantar fasciitis by exerting excessive stress on the calcaneal tuberosity.

Other studies have also suggested that plantar fasciitis is not actually due to inflamed plantar fascia, but it may be a tendon injury that affects the short flexor muscle of the fingers located immediately in the deep part of the plantar fascia.