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Plantar fasciitis: symptoms, therapy, prognosis

by Josephine Andrews
Published: Last Updated on 128 views

Plantar fasciitis (also: plantar fasciitis) is an inflammation of the tendon plate of the sole of the foot and is typically triggered by overuse. The attachment of the tendon plate on the heel bone is usually affected. Plantar fasciitis is manifested by heel pain, which occurs primarily under pressure and strain. Read everything you need to know about plantar fasciitis symptoms and treatments.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

M72

quick overview

  • Symptoms: heel pain (increasingly worse), morning start-up pain, gait disturbances
  • Treatment: Conservative through relief, cooling, painkillers, cortisone for a short time, stretching exercises, shoe inserts, splints, tape bandages, physiotherapy with massages, extracorporeal shock wave therapy (ESWT), x-ray inflammation radiation, surgically with open incision
  • Prognosis: After conservative treatment or surgery, the prognosis is usually good. Healing is possible within six months, sometimes takes one to two years.
  • Diagnosis: Physical examination with medical history, X-ray and ultrasound examination, magnetic resonance imaging (MRI)
  • Causes: Overloading and irritation of the plantar tendon (often during sports or when the Achilles tendon is shortened), injuries
  • Prevention: Appropriate and stabilizing footwear, orthopedic insoles, warm-up and stretching exercises before sport, stretching exercises after sport

What is plantar fasciitis?

The term plantar fasciitis is understood by physicians as irritation and inflammation of the tendon plate (plantar fascia) under the foot caused by overuse. It is usually very stressful for those affected and severely restricts them in their everyday activities, especially when running. Women are affected more often than men.

The plantar fascia originates at the lower and front edge of the heel bone, the so-called heel bone tuberculosis (tuber calcanei). It connects the tarsal to the metatarsal bones and the metatarsophalangeal joints. Everything together forms the longitudinal arch of the foot.

When the foot rolls over, the plantar fascia is put under tension by the so-called windlass effect, which ensures the transmission of power from the forefoot to the rear foot. The fascia’s job is to stretch the longitudinal arch, align the rear and forefoot, absorb shock, and passively lift the arch of the foot.

The term plantar fasciitis is based on the Anglo-American term “plantar fasciitis”. In relation to the disease (pathology) and anatomy, however, the symptoms correspond to the “heel pain syndrome”, while “plantar fasciitis” means a clinical picture that spreads over the second sphenoid bone and metatarsal bone.

The term “heel spur” is often used incorrectly. However, a heel spur is a bony projection (spur) on the heel bone (calcaneus) in the attachment area of ​​the tendon plate of the sole of the foot (plantar fascia). It is often an incidental finding on a lateral x-ray of the foot. Although it is associated with plantar fasciitis, it is not its trigger and usually does not cause any symptoms. The heel spur does not trigger the heel pain, but the plantar fasciitis.

What are the symptoms of plantar fasciitis?

The onset of plantar fasciitis is insidious. Symptoms gradually worsen over time, usually over weeks or months. The symptoms, which mainly include heel pain (calcaneodynia), initially only occur under stress, later also in the morning when getting up and at rest. Those affected usually report burning or pulling pain under the foot or in the heel area. They sometimes lead to the inability to walk .

A sign of plantar fasciitis is heel pain immediately after getting up ( starting pain ), which disappears again after a short period of walking. During sports, too, those affected initially feel painful episodes at the beginning of the exertion, which decrease with increasing warm-up. Towards the end of training, the symptoms return. Sprinting and jumping, in particular, increase the pain.

How is plantar fasciitis treated?

Plantar fasciitis is one of the most persistent and frustrating sports injuries. Although there are many conservative and surgical treatment options, plantar fasciitis more commonly—up to 20 percent of the time—becomes a chronic condition.

Conservative treatment

To reduce the inflammation and pain associated with plantar fasciitis, treatment initially consists of relieving or modifying exercise patterns . The doctor analyzes the training methods and circumstances, for example mountain runs, running surfaces made of sand or scree, sudden increases in training, and suggests a change if necessary.

Stretching exercises: For the calf and plantar muscles, stretching exercises are an essential part of the conservative treatment of plantar fasciitis. In one study, 72 percent of patients improved their symptoms with stretching alone.

For example, one stretch consists of rolling your foot over a bottle filled with ice. Passively flexing the foot with a towel wrapped around the forefoot and pulled toward the head is also a good stretch. Doctors and therapists recommend repeating the stretching exercises about three times a day for at least ten minutes.

Shoe inserts: Shoe inserts that support and straighten the longitudinal arch pointing towards the middle of the body and thus relieve the fasciae have a positive effect. Night positioning splints in the extended position of the upper ankle joint help especially with severe pain in the morning.

Tape bandages/bandages: Tapes and bandages can be used to stabilize the foot and the arch of the foot. Both cushion the pressure on the tendon when walking, thereby reducing stress and heel pain.

Physiotherapy: Special massages such as cross-friction massages at the tendon attachment are uncomfortable at first, but help to relieve pain. Targeted foot muscle training is also part of the therapy.

Weight reduction: Overweight people are more prone to plantar fasciitis because the plantar tendon is under greater stress. If there is inflammation and also severe obesity, weight reduction is often part of the therapy.

Medication:Non-steroidal anti-inflammatory drugs (NSAIDs) are suitable medications. Injection therapy with cortisone is another option, sometimes up to 70 percent of the pain disappears. However, repeated injections may reduce the metabolism of the tendon tissue so much that the risk of a rupture increases.

Extracorporeal shock wave therapy (ESWT): In extracorporeal shock wave therapy, ultrasonic shock waves are delivered to the injured region through the skin. The method has become increasingly important because of its good success in physical therapy to improve movement and reduce pain. Because treatment costs are very high, doctors initially treat only chronic cases and those that do not respond to other conservative measures.

X-ray inflammatory radiation: Doctors also use what is known as X-ray inflammatory radiation for plantar fasciitis that has been treated conservatively without success. About two-thirds of the patients treated with it become pain-free. However, the disadvantage is the radiation exposure.

Surgical treatment by indentation

In rare cases where there is no improvement after six months despite conservative measures, doctors consider surgery. This is usually reserved for cases that do not respond to conservative treatment attempts – about five percent of all sufferers with plantar fasciitis are operated on.

The open incision is the standard method of surgical treatment of plantar fasciitis. The plantar fascia is notched at the origin via a short, sloping skin incision over the point on the sole of the foot where the pressure pain is strongest. This immediately reduces the tension in the tendon. In addition, painful scarring can be avoided. If there is a heel spur, it can also be removed at its base.

After the operation, those affected wear a lower leg splint for about two days. After that, it is important to use a careful partial load in the first few days, with special insoles serving to provide additional relief. Physiotherapy with a targeted strengthening and stretching program for the foot muscles is also required.

After the sixth postoperative week, it is possible to slowly increase the running load, although initially only light endurance training is recommended. Jumping loads are strongly discouraged before the tenth to twelve week after the operation. The entire healing takes at least twelve weeks, in some cases even up to a year.

Endoscopic treatment is also possible. The healing time is then usually shorter.

complications of the operation

As a complication, for example, the pain after an operation persists or migrates to the metatarsus. This happens when the entire plantar fascia has been severed because the tension in the longitudinal curvature has changed. As with any operation, general operation risks such as superficial or deep infections, painful scars or deep vein thrombosis cannot be ruled out.

Other treatment options

Pain ointments are home remedies that help with plantar fasciitis . They are available in drugstores, for example, and contain active ingredients such as arnica . This herb from the blossoms of the alpine flower is said to have a pain-relieving and anti-inflammatory effect. It should be noted that these ointments contain active ingredients in low concentrations and an effect has not been clearly medically proven.

The same applies to alternative medicines with castor oil or capsaicin . Castor oil stimulates the formation of collagen in particular and is said to strengthen the structure of tendons, among other things. In addition, it has an anti-inflammatory effect. Capsaicin is widely used as a painkiller in the form of patches and ointments, especially in sports.

Cold also works to a certain extent against pain and reduces the burning sensation in the sole of the foot. Doctors therefore recommend cooling the foot in acute heel pain . Cool packs or quark wraps are suitable for this.

Heat is an equally helpful remedy for heel pain. Like cold, it stimulates blood circulation and thus stimulates the body’s self-healing powers. But it also provides relaxation and loosens hardened tissue. Massages with heated, skin-friendly oils are therefore well suited as a supportive measure in the treatment of plantar fasciitis and can be carried out at home.

Alternatively, there are approaches to treating plantar fasciitis in homeopathy. The therapy is considered holistic and includes, for example, the diet of the person concerned. It is advisable to consult a doctor who specializes in homeopathy.

Home remedies and homeopathy have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

What are the chances of healing from plantar fasciitis?

For the majority of those affected with plantar fasciitis, conservative treatment methods are successful and a cure is possible in 80 to 90 percent of cases. However, the course of the disease or the healing process is often lengthy and lasts one to two years. Doctors advise athletes to severely limit their exposure during this time. After surgical treatment, about nine out of ten patients, including athletes, report an 80 percent improvement in their symptoms.

How do you diagnose plantar fasciitis?

If plantar fasciitis is suspected, general practitioners or orthopedic specialists are the first points of contact. Plantar fasciitis has a characteristic medical history (anamnesis), which means that the diagnosis can be made quickly. Typical questions asked by the doctor during the anamnesis interview are:

  • Have you injured your foot?
  • Does it hurt under the heel when you put weight on it?
  • When does the pain appear? With which movements?
  • When is the worst pain? When do they let up?
  • Where does the pain radiate to?

During the examination, the affected person usually reports localized pressure pain under the heel at the base of the fascia. A rupture would show bruising on the sole of the foot with tenderness.

If the symptoms occur acutely, it is probably a strain or, in rare cases, a (tear) tear of the plantar tendon. The person concerned states that due to the pain, further strain and walking were no longer possible. However, the symptoms got worse. Sometimes a swelling or hematoma can indicate other injuries, such as fractures, muscle injuries, or a tear.

Imaging diagnostics

For a more detailed diagnosis of plantar fasciitis, doctors use ultrasound and magnetic resonance imaging (MRI) in addition to X  rays .

roentgen

Lateral X-rays show a heel spur in about 50 percent of people with plantar fasciitis. However, this is not a diagnostic criterion and occurs in about 25 percent of the population. To rule out a hindfoot malposition, doctors take x-rays of the foot in three planes.

Ultrasonic

In the ultrasound, the doctor sees a thickened plantar fascia in plantar fasciitis in a longitudinal section. The plantar fascia has a thickness of three to four millimeters in a healthy person, while in plantar fasciitis the fascial layers are often thickened to seven to ten millimeters.

Magnetic resonance imaging

With the help of magnetic resonance imaging (MRI), the doctor takes precise cross-sectional images of the foot. For a better assessment, the doctor usually uses a contrast agent that he injects into the blood through the vein. The MRI can be used to determine the exact localization and extent of the inflammation. The use of MRI is particularly useful before an operation, also in order not to overlook possible fractures, partial fractures, tendon abnormalities and bone contusions.

What causes plantar fasciitis?

Plantar fasciitis is mainly caused by overloading the plantar fascia. This often occurs in connection with sports , especially running or jumping. Plantar fasciitis is particularly common in the fourth and fifth decades of life, which is probably related to age-related wear and tear. About ten percent of all athletes in the running disciplines are affected by plantar fasciitis. Other high-risk sports include basketball, tennis, soccer and dancing. There is no connection between training duration and frequency of symptoms.

If the fascia becomes inflamed at the base (insertion tendinopathy) due to excessive strain, corresponding symptoms occur. Excessive strain is caused, for example, by a shortened Achilles tendon . Bursitis in the area of ​​the plantar fascia attachment also causes pain in this area.

In addition, injuries are sometimes the cause of plantar fasciitis. Even the smallest changes sometimes cause damage to the collagen fibers and thus lead to chronic inflammation. For example, patients report getting their heel caught on the curb when crossing the street.

Can plantar fasciitis be prevented?

Since plantar fasciitis is usually due to overloading untrained muscles and the corresponding tendons, doctors advise athletes in particular to always warm up their muscles well before exercising . Stretched muscles and tendons are less likely to become inflamed or torn. Stretching exercises help preventively both before and after sport. This also applies to activities in which people run or jump a lot – whether professionally or in their free time.

The right shoes are also important. Wearing shoes with good support and cushioning can help prevent inflammation of the plantar tendon.

In order to prevent renewed plantar fasciitis, it is advisable to permanently use special insoles (ortheses) in the shoes or tapes for stabilization after successful treatment. Doctors also advise overweight people to lose weight .

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