When it is overused, it can get damaged. Your body will try to repair this damage with an inflammatory reaction.
The signs of this inflammatory reaction are:
Not all these symptoms have to be present but usually swelling, pain and reduced mobility are present. The swelling of the plantar fascia can only be measured through ultrasound examination.
What are plantar fasciitis symptoms?
There are a few plantar fasciitis symptoms that are very specific. These symptoms usually start during walking or running for a long period of time. In the end, the pain under your foot starts to occur.
As the injury progresses, symptoms start earlier over time. When the symptoms are at most worse, pain is always present. The following symptoms will always be present in severe plantar fasciitis:
The first one is the location of the pain. The location of the pain is always the same and always at the same spot in.
You can see the location of the pain on the picture above.
If there is no pain at that specific location it’s safe to say that you don’t have plantar fasciitis. When this happens you should search for a different cause for your pain.
The location of the pain is always at the front side of your heel bone under your foot at the medial or inner side. It’s at one specific point and doesn’t radiate. It feels like a sharp pain.
The second very specific symptom is a pain in the morning. You will feel the most pain in the morning when you get out of bed. At this moment your foot has been resting for 8 hours. This results in stiffening of your plantar fascia. The stiffness causes more pain. When you walked around a bit or stretched a bit, the pain will disappear.
Also pain during walking or running for a longer period of time causes more pain under your foot. This is caused by overusing your foot by doing this. This results in more damage and therefore more pain.
Lastly, when it hurts more to walk barefoot than to walk with shoes, this is an indication for plantar fasciitis. When you walk barefoot you put more pressure on your plantar fascia. This also results in more damage causing more pain.
How to diagnose plantar fasciitis?
To properly diagnose plantar fasciitis several things are important.
First, the specific symptoms described above have to be present. If your symptoms are different it’s safe to say that you don’t have plantar fasciitis but a different foot problem.
In addition to the symptoms, the history of the injury has to fit in. This means that the pain started slowly, first only at the end of a long walk or run. As the injury progresses, the pain starts earlier and earlier until it’s always present.
Finally, an ultrasound image can confirm the actual swelling of the plantar fascia that is characteristic for plantar fasciitis.
If you only have either the symptoms without the swelling or the swelling without the symptoms, the plantar fascia is not the problem. A swollen fascia can be present without producing symptoms.
In order to be able to understand this, it’s good to know that the image doesn’t always tell the whole story. There are dozens of examples where an ultrasound image shows a tear in a muscle or a tendon without any symptoms. On the other hand, there can be symptoms without anything showing in the image. That’s why you have to look at the image and the symptoms combined.
A misdiagnosis can lead to unnecessary long treatment with little results. A very good example is a heel spur or calcaneal spur that might be found on an ultrasound image. That is something completely different and often has nothing to do with your symptoms. I’ll explain right now why.
What causes plantar fasciitis?
It is typically caused by overuse of the foot. The overuse caused the damage of the plantar fascia. There are actually 5 factors that can cause the overuse of your plantar fascia.
I’ll explain why they have such a big impact on your plantar fascia and later I will show you how you can use this knowledge for your treatment.
Being overweight is one of the biggest risks for developing pain under your foot. As I mentioned before, your plantar fascia carries about 14% of your total weight. This means that the bigger your weight, the bigger the load your foot have to carry.
When this load is bigger than your plantar fascia can handle, it will get damaged. Research shows that being overweight increases your risk by 5,6%.
Standing for a long period of time
The same research shows that standing for a long period of time increases your risk by 3,6%. This is because a lower load can also cause damage if it is applied for a long period of time.
Another study shows that having flat feet increases your risk for developing plantar fasciitis.
When you have flat feet, your plantar fascia is more stretched. This applies a higher load, causing damage.
Weak Calf muscles
Another big factor is weak calf muscles. Unfortunately, there is not much research done examining the link between weak calf muscles and plantar fasciitis. However, in my experience, everyone with plantar fasciitis has weak calf muscles. Because of the lack of research, I can’t say if the weak calf muscles are caused by the plantar fasciitis or that it’s the other way around. What I do know is that it is something we have to address and treat.
The last risk factor is reduced dorsiflexion of your ankle joint. This means that you’re unable to lift up your foot far enough.
Research shows that people with 0 degrees dorsiflexion have a 23,3% higher chance of developing plantar fasciitis then those with 10 degrees dorsiflexion.
The amount of dorsiflexion is measured from a neutral position. The neutral position of the ankle is when your foot and lower leg are in a 90 degrees angle. This is for instance when you’re in standing position.
Healthy people are able to make about 20 degrees of dorsiflexion in the ankle joint.
Now you know the most common causes for developing plantar fasciitis, it’s time to learn why this causes plantar fasciitis.
To fully understand this, you first have to know the anatomy of the lower leg.
First, on the back of your lower leg, you have your calf muscles. Your calf muscles are connected to your heel bone through your Achilles tendon. Right after your Achilles tendon starts your plantar fascia. Around your plantar fascia, you have several foot muscles. These 5 structures form a chain that is very important during walking:
• Calf muscles • Achilles tendon • Heel bone • Plantar fascia • Little foot muscles
When one of these structures don’t function properly pain will start to develop. That is because more pressure will be applied on the end of the chain, which is your plantar fascia.
This also explains the risk factors for developing plantar fasciitis. Short and tens calf muscle reduce the dorsiflexion of your ankle, along with reduced mobility of your heel bone. This increases the load on your plantar fascia.
When your little foot muscles lack the strength to support your foot, you develop flat feet. This increases the load on your plantar fascia.
So in order to cure your plantar fasciitis fast and effective, your treatment have to adjust all these issues.
And I’ll show you how to do this right now:
Plantar fasciitis treatment with 4 strengthening exercises
There are several plantar fasciitis treatments available. However, some are more effective than others.
But before you start your treatment, there are several things you can do to reduce your symptoms.
The most important thing you have to do is to give your plantar fascia as much rest as you can.
The rest is needed to reduce the inflammation.
I know it’s very hard to give your foot rest because you have to use it always.
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When you’re walking you are using your plantar fascia. This causes the irritation to become worse and worse. By limiting your activities you give your plantar fascia time to recover. This also applies to stand for a long time.
Secondly, you should wear the right shoes. The right shoes are shoes that give a lot of support and reduce the pressure on your plantar fascia. Good examples are sneakers or walking shoes. Bad examples are high heels, boots or flip-flops.
Now you know what not to do so let’s start talking about the exercises you can do to relieve your pain.
Plantar fasciitis exercise 1: Stretching your calf muscles
The first thing you should do is stretching your calf muscles.
As I’ve shown you before tight calf muscles is one of the causes of plantar fasciitis. It reduces the mobility of your ankle and increases the stress on your plantar fascia.
Also, tight calf muscles can cause radiating pain to your heel, mimicking plantar fasciitis.
The following plantar fasciitis stretch stretches your calf muscle:
Place your painful foot behind you in a straight line with your other foot
Extend your hip and knee and keep your heel on the ground
You will feel the stretch in your calf muscle
Hold this position for 20 second
Repeat this 3 times
You can also find the exercise in the video below:
After a few days, you will feel that your calf muscles get looser and hurt less. >
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Plantar fasciitis treatment 2: Dry Needling
With Dry Needling your physical therapist is able to solve the tension in your calf muscle almost instantly. This will give you immediate pain relief.
Therefore, in my opinion, Dry Needling is the most effective plantar fasciitis treatment out there. It wasn’t until recently that I started to use Dry Needling as a plantar fasciitis treatment. My experience is that it gives imminent relieve. This means that patients feel less pain under their foot right after the Dry Needling session.
So how does this work?
Dry Needling is not performed directly to your plantar fascia. This doesn’t work. Instead, it is used to reduce the tension of your calf muscle. As you might remember, I talked about a stiff calf muscle as one of the causes for plantar fasciitis. The stiff calf muscle increases the pressure on your plantar fascia. By reducing the tension of the calf muscle, you also reduce the pressure on your plantar fascia. This reduces your pain.
It’s very important that you combine Dry Needling with the calf and Achilles tendon stretches.
Another useful technique for pain relieve is taping. This technique reduces the pressure on your plantar fascia, which reduces your pain. When this taping technique is applied, you will feel an imminent relieve of pain.
The downside of this treatment is that it only works as long as the tape is applied. As soon as the tape goes off, the pain will return like before. It serves more like a painkiller than a cure.
Plantar fasciitis treatment 4: shockwave therapy
Another widely used treatment is shockwave therapy. Shockwave uses small pulses to increase blood flow in the tendon and also to destroy calcification, if present.
This is a great addition to the exercises described here because it helps to heal the inflammation as well as solving any additional problems.
What shoes are best when you have plantar fasciitis?
The best shoes to wear are those that reduce the pressure on your plantar fascia. The best shoes, therefore, are firm, solid shoes.
Sandals and flip flops on the other hand usually give less support for your foot and therefore aren’t your best option.
However, with the right insoles, even sandals can be worn pain free.
What can I do to prevent plantar fasciitis to occur?
Like always, it’s better to prevent something then to cure it afterward. The best way to prevent plantar fasciitis is minimizing the risk factors.
Maintain a healthy weight.
Keep your calf muscles and Achilles tendon relaxed and at length.
Keep your foot muscles strong to reduce flat feet.
Wear the right shoes.
Keep your ankle flexible
You can perform the plantar fasciitis exercises mentioned before to do all this.
Plantar fasciitis surgery
If you have tried every possible treatment option without success, plantar fasciitis surgery is your last resort. According to the American Academy of Orthopaedic Surgeons, this surgery can be performed after a period of at least 12 months of pain.
Basically, there are 2 surgery options.
The first option is surgically lengthening of your calf muscle.
As you know reduce dorsiflexion is a risk factor for plantar fasciitis. Reduced dorsiflexion is often caused by short calf muscles. When excessive stretching doesn’t lengthen your muscles enough, you can have this done surgically. It reduces the tension on your plantar fascia, which gives it a chance to heal.
Your second option is a plantar fascia release.
In this procedure, the surgeon partly cuts your plantar fascia to reduce the tension on it. When the tension is reduced, the fascia can heal, relieving your pain.
Complications of these surgery procedures might be insufficient healing or nerve damage. Unfortunately, It doesn’t have a 100% success rate and therefore it’s considered a last resort.
Only undergo surgery if everything else has failed.
Conclusion There is a lot you can do yourself to relieve your pain. Try the stretches first and if that doesn’t help, find a good physical therapist. You don’t have to live with this pain.
If you have any question after all this information feel free to e-mail me: [email protected]. We will try to enter the answers into this post to keep improving it.
Don’t forget to share it with your friends so everyone can benefit.
Note: This information can never substitute your doctor. If you are not certain about your condition or the exercises don’t work or make it worse you should see your doctor.