Plantar Fasciitis: A foot condition many Africans might never have heard about

 

By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer. Medical review and editorial support provided by the DLHA Team

Illustration of healthy foot and foot with plantar fasciitis. Click image to enlarge. Image credit.

 

Highlights 

• Plantar fasciitis happens when the strong fibre-like tissue (plantar fascia) that connects the heel bone to the bones in the ball of the foot gets irritated, stretched or torn.

• Plantar fasciitis can arise for no apparent reason, but there are a few things that can make it more likely for you to get it.

• People with plantar fasciitis typically feel more pain in the inner and lower parts of their heels, and in severe cases, the pain might spread upward into the leg.

• Doctors can diagnose plantar fasciitis by talking to the patient and examining their foot.

• Most people with plantar fasciitis get better within a year without surgery.

• If the basic treatments don't help with the pain, you might consider more advanced options. However, it's important to try simpler treatments first and give them at least six weeks to work.

 

Introduction

Waking up in the morning should feel like a fresh start, but for many, it's a painful reminder of a common foot problem that many including Africans might never have hear of -  namely plantar fasciitis.

If you've ever felt a sharp pain in your heel or winced with each step, you're not alone. Plantar fasciitis affects millions worldwide, making simple activities like walking or standing uncomfortable.

 In this article, we’ll explore -

• What causes this issue,  
• Its symptoms, & most importantly,
• Effective ways to find relief and get back to pain-free living.

 

Anatomy of foot

The foot is a complex mechanical system of the human body. It has 33 joints, 26 bones, and over a hundred muscles, tendons, and ligaments. All of these work together to support your weight, permit movement, and transmit the force impacting your foot.

The two primary functions of the foot joints are weight-bearing and propelling during activities like walking, running, and jumping. To be able to carry out these tasks, the foot needs to be very flexible and stable. This flexibility comes from the large number of joints in the foot.

However, stability in the foot is the result of how the joint are connected (articulation) and the foot's capacity to function as both a stiff and a flexible lever during the normal gait cycle. [1]

 

What is plantar fasciitis?

Plantar fasciitis happens when the strong fibre-like tissue (plantar fascia) that connects the heel bone to the bones in the ball of the foot gets irritated, stretched or torn (see fig. 1)

Fig. 1: Inside view of the the foot illustrating common location of pain in plantar fasciitis. Click image to enlarge. Image Credit

 

The plantar fascia, which has three parts originating from the heel bone, is important for normal foot movement and helps support the arches (curvatures) of the foot while absorbing shock. Despite its name suggesting inflammation (-itis), there are no inflammatory cells involved in this condition. [2]

 

How common is plantar fasciitis?

Each year, it is estimated that approximately one million people globally see their primary care doctors (General Practitioner or GP) due to foot pain. Plantar fasciitis or plantar fasciopathy accounts for about 60% of those visits.

Plantar fasciitis is quite common, affecting around 10% of people globally at some point in their lives. Women aged 40 to 60 years are affected most. Among adults, it's the most common cause of heel pain. While it can be triggered by various activities, most cases (about 5% to 10%) occur in both serious and casual runners. [3]

Specific information about how common plantar fasciitis is in African countries are negligible. One hospital based review of ten cases from Nigeria documented patterns of occurence that were similar to the global situation and concluded that the condition is most likely underdiagnosed in the country. [4]

 

What are the functions of the plantar fascia?

Three important foot features help us walk and run efficiently: 

1. a big toe that angles inward slightly, 
2. a strong arch in the middle of the foot, and 
3. a tough band of tissue called the plantar fascia. 

These features make the foot act like a solid lever when pushing off the ground and help it handle weight when landing. The plantar fascia, which runs along the arch and connects the heel bone to the toes (see figure 2), is crucial. It plays a key role in maintaining the foot's arch (see figure 3) through something called the windlass mechanism. When you lift your toes upward, the plantar fascia, which contains small bones near the base of your toes, gets pulled. This action pulls the heel bone towards the toes, lifting and shortening the arch.

If the plantar fascia is strong enough to keep its shape, the bending of the toes and the lifting of the arch should happen together. [5]

Why causes plantar fasciitis?

Plantar fasciitis often happens due to small tears in the plantar fascia, caused by repetitive stress on the foot. But it can also be triggered by injuries or other factors.

• Flat feet
• High arches of the foot
• Limited ankle movement
• Long periods of standing or jumping, and
• Excessive inward or outward rolling of the foot can all play a role. [2]

 

Who's at risk for plantar fasciitis?

Plantar fasciitis can arise for no apparent reason, but there are a few things that can make it more likely for you to get it.

 Among them are:

• Age: Plantar fasciitis is most common between the ages of 40 and 60.

• Foot stress factors: It can develop from activities that stress your heel and its connecting tissue, like long-distance running, ballet, or aerobic dance.

• Foot anatomy: Factors like flat feet, high arches, or an unusual walking style can affect how weight is distributed when standing, putting extra strain on the plantar fascia.

• Weight: Being overweight adds more strain to the plantar fascia.

• Occupational factors: Jobs that involve a lot of walking or standing on hard surfaces, such as factory work or teaching, can also increase the risk of plantar fasciitis. [6] 

 

What you might feel: Common symptoms of plantar fasciitis

Pain. This is the most  significant complaint that you have with plantar fasciitis. The pain occurs more commonly in one foot and rarely in both. You may feel it more in the inner and lower parts of your heels. In severe cases, it may spread forward towards your toes or upward into your leg. You may also feel the pain most when you take your first steps after waking up in the morning.

Standing or sitting for a long time can make your pain worse. You feel more soreness on touching and moving your foot or toes, usually at the spot where the plantar fascia connects to the heel bone (see fig. 1) [2]

 

How is plantar fasciitis diagnosed?

Doctors diagnose your plantar fasciitis by talking to you and examining your feet.

You doctor will consider these additional and important points:

• If pressing on the front and middle parts of your heel causes a lot of pain.

• If your pain usually starts when you begin walking after resting, improves as you keep moving, but returns later in the day.

• If you report your pain as being worst in the morning.

• Whether your foot pain is accompanied by numbness or tingling sensations. These aren’t common in plantar fasciitis.

• If you report recent increased activities that involve standing or walking. [3]

 

Treatment  of plantar fasciitis

Non- Surgical 

Most people with plantar fasciitis get better within a year without surgery. The first steps for treatment include –

• Changing lifestyle activities

• Icing the foot

• Taking anti-inflammatory pills

•  Stretching

•  Doing exercises to strengthen the foot, and

•  Using pads in the shoe

The American College of Foot and Ankle Surgeons suggests adapting treatment to fit each person's symptoms, lifestyle, and activity level rather than following a strict treatment plan. This is because many treatments don't have strong scientific evidence, even though they often help when used. [3]

Changing lifestyle activities

You should consider modifying or staying away from activities of daily living that causes you pain.

Medicines

You can buy non-prescription pain relievers like ibuprofen or paracetamol and use as recommended by your pharmacist or as instructed on the drug label.

Therapies

• Stretching/strengthening

Your physical therapist can show you how to use stretch exercises to relieve your foot pains and strengthen your calf muscles. [3]

By lessening the strain on the fascia, foot orthoses are believed to lessen the symptoms of plantar fasciitis.[3]

• Taping

Your therapist can also teach you how to support the bottom of your foot by taping. This involves adjusting the ankle joint to reduce stress on foot. Research has shown that taping can provide short-term relief from the discomfort of plantar fasciitis. However, its effects tend to diminish over time.

• Dry needling & Acupuncture

Your therapist may use dry needling and acupuncture to treat your plantar fasciitis. It is believed that the procedures work by changing the local blood flow and biochemical environment. A myofascial trigger point can be treated with a tiny needle to reduce discomfort.

• Evening splints

Your therapist might recommend the use of a night splint during sleep to keep your ankle dorsiflexed or neutral to avoid contraction of the calf muscles. [3]

• Foot support (Orthotics)

Your therapist might recommend that you use special products made to support the arch of your foot. These products are called orthotics and are known to help distribute pressure on your feet evenly.

• Use of boots, canes or crutches

Your therapist might recommend that you wear boots to limit movements or use of canes or crutches to reduce weight bearing on your foot for a short period.

Surgical & Other Treatments

In the event that several months have passed and more conservative measures are still ineffective, your healthcare provider may suggest:

• Injections 

Temporary pain relief may be achieved by injecting steroid medication directly into the painful area. It is not advised to have many doses since this may weaken your plantar fascia and perhaps result in a rupture.

• Shockwave Therapy 

To promote healing, sound waves are aimed at the heel pain location. This is for long-term plantar fasciitis when more conservative measures have failed. Although this therapy hasn't been proven to be consistently successful, several trials have produced encouraging results.

• Tissue repair with ultrasound guidance. 

With the help of ultrasound imaging and using a minimally invasive technique, a needle-like probe is inserted into the injured plantar fascia. After that, the injured tissue is broken up by fast vibrations at the probe tip. The residue are then sucked out.

• Surgery

Surgery is rarely required to separate the plantar fascia from the heel bone. Usually, it is only a possibility if all other forms of treatment have failed and the pain is severe. [7]

Surgery should only be thought about if nothing else works, usually after trying non-surgical treatments for six to twelve months. [2]

 

Summary

Heel pain often comes from a condition called plantar fasciitis, caused by stress on the tissue at the bottom of your foot from repetitive activities. Doctors usually diagnose it by where the pain is felt on the inside of the heel bone. Risk factors include getting older, being female, being overweight, spending a lot of time on your feet, and doing the same activities over and over. 

Most of the time, simple treatments work well. These can include pain relievers, wearing a splint at night, doing specific stretches, and seeing a specialist if the pain doesn't improve after six to twelve months. Surgery is only considered if nothing else helps. [8]

 

References

1.  Manganaro D, Dollinger B, Nezwek TA, Sadiq NM. Anatomy, bony pelvis and lower limb, foot joints. In: StatPearls [Internet. Last update 2023 Aug. 21]. Treasure Island (FL): StatPearls Publishing [Cited 2024 Jun 11]. Available from here.

2.  Buchanan BK, Sina RE, Kushner D. Plantar Fasciitis. In: StatPearls [Internet. Last update 2024 Jan. 7]. Treasure Island (FL): StatPearls Publishing [Cited 2024 Apr 20]. Available from here.

3.   Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019;99(12):744-750 [Internet]. [Cited 2024 Apr 16]. Available from here.

4.  Nottidge TE and Nottidge BA. The overlooked menace of plantar fasciitis in the Nigerian setting, with a contextualized treatment protocol. Ibom Med. J. 2020.13(2). DOI: https://doi.org/10.61386/imj.v13i2.185. Available from here. 

5. Welte L, Kelly LA, Kessler SE, Lieberman DE, D’Andrea SE, Lichtwark GA, et al. The extensibility of the plantar fascia influences the windlass mechanism during human running. Proc R Soc B [Internet 2021 Jan. 20]. Cited 2024 Apr 21. https://doi.org/10.1098/rspb.2020.2095. Available from here.

6.  Mayo Clinic. Plantar Fasciitis - Symptoms and Causes. [Internet 2023 Sept. 7]. Cited 2024 April 20. Available from here.

7.  Mayo Clinic. Plantar Fasciitis - Diagnosis and Treatment [Internet 2023 Sept. 7].Cited 2024 April 20. Available from here.

8. Thompson, John V., Saini, Sundeep S., Reb, Christopher W. and Daniel, Joseph N.. "Diagnosis and Management of Plantar Fasciitis" Journal of Osteopathic Medicine, vol. 114, no. 12, 2014, pp. 900-901. https://doi.org/10.7556/jaoa.2014.177. Available from here

 

 

Published: June 12, 2024

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