Plantar Fascia Foot Pain, Symptoms, Causes and Treatment
Painful Heel due to Plantar Fasciitis
A healthy Foot
A Chinese Woman With Feet Unwrapped
Deformity caused by foot binding, an ancient Chinese Practice
Be Kind to your feet
© J Alexis-Hagues
Heel pain is a common condition of the foot, in most cases, the condition is caused by damage to the plantar fascia, a disorder known as Plantar fasciitis.
From time immemorial, proud parents have cheered with joy as their toddlers progress from all fours to take those first few vital steps.
A baby's first walk is a landmark event that most mums and dads would hate to miss. A child's first walk is an important milestone like the first feed, the first smile and the first spoken words. Walking is a natural process, we've done it most of our lives without having to think about it, but the big question is, are we doing it right?
Just as a good building requires a good structural foundation to stand strong, the human body needs good healthy feet for a lifetime of support, weight bearing and locomotion. An average moderately active person is said to take 7,500 steps/day. If that person maintains the average and lives to a ripe old age of 80 years, he/she will have walked a distance of 110,000 miles.
The human foot is an incredible feat of bioengineering that took over 4 million years of evolution to perfect. According to the experts, we don't give our feet the respect it deserves. Our feet is what carries us along, taking the full weight of the body, allowing us to go about our daily business.
It's true, we no longer walk as many miles as our ancestors once did, with the advent of the motor vehicles. However, we still find new and interesting ways to punish our feet. We began to wear shoes to protect the feet, but protection has evolved into fashion and more imaginative ways to torture our feet.
Women particularly are prepared to tolerate excruciating pain in the name of fashion. As late as 1949 the barbaric culture of foot binding was still practiced on young women in China. Foot binding was done to achieve the ideal foot length of 3 inches. The practice began in ancient China around the 10th century, when a woman with tiny feet was a highly prized possession, beautiful and more desirable. But it also showed that such women made ideal wives because they were uncomplaining. Known as the " Golden Lotus," young women's feet would be tightly bound with cotton or silken bandages. In some cases the toes would be folded under the feet with many of the bones at the top of each foot broken, the ball of the foot buckled in, then wrapped to the heel.
Fast forward to the present day, while not as extreme, we are still abusing our feet in the name of fashion. Women continue to force their feet into shoes that are poorly fitted, wear ridiculously high heels that squeeze the foot into painful and unnatural position resulting in malformation, heel pain, bunions, arthritis, arch pain, the ball of foot pain and a lot of other conditions.
High heel shoes cause the weight to be transferred to the ball of the foot, stretching and damaging the fascia. The shoes we wear can affect out posture, putting the spine out of its natural alignment. Recently published 3-D scans showed the damage that can be caused by wearing high heels. According to the experts, by wearing shoes, we no longer walk correctly. But walking is easy, even a toddler can do it, I hear you say....you'd think so, wouldn't you? Think again.
A South African university research published in the podiatry journal "The Foot" found that we still haven't perfected the art of walking, in short, the way we walk is wrong, and this is mostly due to our shoes.
The study titled "Shod Verses Unshod" looked at 180 modern humans from three different population groups (Sotho, Zulu, and European) the feet of each group was compared to each others and also to 2000 years old skeletons. The study concluded that before the invention of shoes, people had healthier feet. In the modern subjects, the Zulu population who often goes bare feet, had the healthiest feet, while the shoe wearing European, had the unhealthiest feet.
However, while the Podiatric Medical Association does not suggest that we all go barefoot walking, we need to be conscious of what shoes we wear, since most of the shoes currently on the market are bad for our feet. Most of the shoes we buy offers little or no support, they are often too tight and made from materials that suffocate the feet.
What is Plantar Fasciitis
Plantar refers to the foot, fascia, connective tissue fibre and -itis an inflammatory process.
Plantar fasciitis is the medical term used to describe the painful condition of the plantar fascia. The plantar fascia is a strong, flexible band of connective tissue fibre that runs from the insertion at the heel, where the fascia attaches to the calcaneus or heel bone. The flexible fibre tissue then fans out along the bottom of the foot supporting the arch spreading out to the bones of the midfoot.
Plantar fasciitis is usually caused by overuse, injury, or muscular abnormalities. The damaged plantar fascia becomes thickened, resulting in pain when walking. The pain associated with plantar fasciitis is not always experienced at the time of the injury, the onset is often gradual and usually located over the middle or inner aspect of the heel.
What is Fascia
Fascia is material that is woven throughout the body to hold us together. The function of the fascia is both generalized and specialized. Fascia is an intricate structure of connective tissue, a web of collagen fibre rather like a thin membrane of cellophane. It wraps tightly around the muscles holding the content together and consists of several thin layers that extend from head to toes.
There are three main types of fascia:
Superficial, associated with the skin
Deep, mainly to do with the muscles, bone, nerve and blood vessels
Visceral, mostly associated with the internal organs
Fascia binds some structure together but also allow others to move smoothly over each other as we move. The fascia protects, separates, connects and hold the organs of the body in their rightful place.
Although the fascial tissue plays a significant role in musculoskeletal medicine, most people are unaware of it, in fact, even the medical community has neglected to study this important part of the body until recently. The first International Fascia Research Congress took place at Harvard Medical School in 2007.
The fascia contains nerves when the nerves are damaged or inflamed; we feel pain. Damaged fascia tissue can affect the whole body, it can cause a problem with movement, as in repetitive strain injury, it can cause headaches and chronic pain. Fascia injury is the most common injury sustain by athletes and is now at the forefront of athletic training.
Like muscles, most fascia has an elastic quality, they are smooth and supple, in optimum condition, it is flexible tissue, most of which are capable of being stretched. However, inactivity, stress, dehydration and other factors can have a detrimental effect on the fascia, causing it to become harder and thickened, a state from which it is hard to recover.
When the fascia in not functioning at its best, when it is stretched beyond its normal capacity, micro-tearing can occur in individual collagen fibre, leading to scarring and adhesion. Once the fascia is damaged, (i.e., stretched, pulled or torn) microscopic fibres becomes deranged, losing the normal levels of flexibility and elasticity, they are no longer organised, they run in all three dimensions resulting in pain. The plantar fascia is a tough triangular sheet of inelastic fibrous tissue that acts as a shock absorber in the foot, the healthy plantar fascia is flexible, but do not stretch, when it does, the result is heel or arch pain.
Fascia Wraps The Entire Body, From Head To Toes
3-D Scan showing the damage we women do to our feet by wearing high heeled shoes
- There are 26 bones in each foot, 33 joints, 107 ligaments and 19 muscles
- 25% of all the bones in the human body are found in the feet. When these bones are out of alignment, so is the whole body
- Most of the body's weight are carried by the two largest bones in the feet, the calcaneus (heel bone) and the talus that is situated between the heel bone and the bottom of the shinbone
- When walking, the toes are forced to takes 50% of the body weight every time the heels are lifted off the ground
- Standing is much more tiring on the feet than walking, because the same group of muscles are used for a longer period of time
- The total amount of force exerted on the feet in an average day of walking, can total hundred of tons
- Walking is the best exercise for the feet and body, it improve circulation and help to maintain body weight and overall health
- Foot problems occur four times more frequently in women than men. This is mostly due to wearing of high heeled and badly fitted shoes
- ( 9 out of 10 women wear shoes that are too small for their feet
- The pressure exerted on the feet when running, can be as much as four times the runner's body weight
Function of Healthy Fascia
Hold and binds muscles together
Allows proper alignment of muscle fibres, blood vessels, nerve and tissues within the muscles
Transmits forces and loads evenly throughout the body
Provide a uniformly smooth lubricant surface
Allow muscles to change shape as they shorten or lengthened
Damage to the Plantar fascia is the most common cause of heel pain in adults. “Up to 40% of the population suffer from painful feet problems at least once during their lifetime, more than 10%, suffer from heel pain that is caused by inflammation of the plantar fascia at some time in their life.
Heel and arch Pain due to Plantar Fasciitis
Heel pain characterized by plantar fasciitis is typically felt on the bottom of the heel and most acutely, with the first few steps of the day, this is known as first-step pain. It can also occur after long periods of inactivity in the day time and can be quite severe, occurring when weight is placed on the heel. Pain and discomfort build up gradually, becoming worse over time.
Individuals who are affected may limp or adopt an abnormal style of walking as they try to avoid shifting full weight to the affected heel.
The condition is often associated with standing for an extended period, with a higher incidence in individuals with an excessive inward rolling of the foot, as seen in people with flat feet. In the non-athletic population, plantar fasciitis is often associated with obesity and lack of exercise.
Plantar fasciitis commonly affects runners, hikers and walkers, even people who earn their living by standing still for lengthy periods of time.
We are now well aware of the tremendous health benefits we can all gain by participating in sports and regular exercise. Exercising not only helps us maintain a healthy body, but also a healthy mind. More people are taking regular exercises now that ever before. Regular exercise can help reduce the risk of serious illness such as heart disease, stroke, diabetes and cancer by as much as 50%, and the risk of early death by up to 30%.
Yes, folks, exercise is the miracle cure, we've ignored for far too long, but like most medicine, when we fail to take the correct dosage we can overdose, and that is never good. There are those who believe that if a little exercise does you good, a lot must be better, but overdoing the workouts can backfire as many athletes have painfully discovered, to their cost.
Causes of strains and tears in the Plantar Fascia
Age, most common in people between the ages of 40 to 60 years
Obesity, extra weight places stress and pressure on the plantar fascia
High arch or flat feet (low arch)
Tight Achilles tendons or calf muscle
Poorly fitted or worn-out shoes
Feet that roll inward too much when walking
Standing, walking or running for long periods on hard surfaces
1 in 10 people will get plantar fasciitis at some time in their life, the best way to prevent it is to ensure that the ankles, Achilles tendons and calf muscles remains flexible, a state where it is less likely to sustain damage.
Do frequent stretches throughout the day.
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Home Treatment for Plantar Fasciitis
Treatment for plantar fasciitis ranges from simple stretching to surgery, but the first course of action for an individual exhibiting symptoms of the condition, is to get sound medical advice. Action to help relieve pain includes:
- Avoid walking or running on hard surface, reduce or change activities that can exacerbate the pain. i.e., cycling rather than running, reduce the distance and duration of walks, swimming instead of jumping. Change exercise surface from concrete to grass.
Use heel cups, shoe inserts or othotics in both shoes
Chose new shoes with cushion sole and good arch support
Do calf and towel stretches several times per day, especially first thing in the morning, this may help to relieve pain
reduce pain and swelling by applying ice pack to the affected area for 15 to 20 minutes, three to four times a day
Wear a night splint
Over the counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help to reduce inflammation and pain. However, NSAIDs can irritate the stomach lining to cause indigestion and in rare cases bleeding. Not recommended for use in individuals with a history of stomach ulcers or bleeding problems.
Medical Treatment for Plantar Fasciitis
In cases where the heel pain do not respond to home treatment, the doctor may administer a corticosteroid injection directly into the damaged ligament. Corticosteroids can also be given by placing the drug on the skin of the heel and the arch of the foot before painless electrical current is applied, allowing the steroids to be absorbed through the skin and into the muscles.
lower leg muscles can be strengthened with exercise, this will help to stabilize walking to lessen the work of the plantar fascia. Deep local massage to the painful area where the fascia attaches, can be effective when done in the morning after a warm bath
Extracorporeal Shock Wave Therapy (ESWT)
The heel is exposed to a bombardment of sound waves to stimulate healing within the plantar fascia ligament. However, this method remains controversial, with research both for and against it's use. ESWT may cause bruising, pain, swelling and numbness.
Surgery is used only in cases where pain is extremely severe.
Night splints is a type of brace that holds the foot in a flexed position to lengthen the plantar fascia and Achilles tendon at night, and help to prevent morning stiffness and pain.
Orthotics or arch supports
Special supports worn in the shoes can help to relieve some pain by distributing pressure to prevent further damage to the plantar fascia. A boot cast can help to immobilize the foot and reduce strain thereby allowing the plantar fascia time to heal.
Shock Wave Therapy
Exercise by Swimming instead of running
Orthotics to Treat or prevent Fascial Injury
To Reduce Pain, Avoid Walking on Hard Concrete Surfaces
Excessive Wearing of Flip-Flops linked to Heel Pain
Measure Shoe Size For Perfect Fitting Shoes
Choose the Best Shoes For Your Feet
No greater than 4cm (1.5 inches) with a broad base
Reenforces the heel cup and stablises the foot on contact with the ground
Should idealy consist of natural materials like leather or fabric that can breathe to maintain comfort
Preferable one that is removable to allow easy insertion of of padding or othoses
Breathable material to keep the feet fresh, should be smooth and seam-free
Laces or straps with buckles or touch fastenings help to hold the foot securely within the shoe
Should have sufficient depth to prevent rubbing and allow the toes to wiggle
Long Gone are the Six Inch Heels of the 80s and 90s I Now Wear Comfy Shoes with the Occasional Touch of Bling
If You Still Want Killer Heels
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