What is Plantar Fasciitis and how is it treated?

Plantar fasciitis is a degenerative process of the collagen and elastin of the fascia bands, due to the excess of tension and impacts that the plantar fascia supports during walking and/or running, in the heel elevation phase and relaxation in the stance phase.

Signs that can indicate that we are suffering a plantar fasciitis

The most acute pain caused by plantar fasciitis is concentrated on the lower and inner side of the heel, where the fascia inserts into the calcaneus, and along its course. The pain during the first steps in the morning, after periods of rest or impact activities is due to the stiffness of the fascia.

What are the causes?

The cause of plantar fasciitis is multifactorial, so there are several groups of factors to consider, including the following.

Intrinsic mechanical risk factors:

  • People between 40 and 50 years of age.
  • Overweight, high BMI, pregnant women
  • Limited dorsal flexion of the ankle
  • Shortening of Achilles tendon, triceps suralis and hamstrings
  • Decreased plantar fat pad
  • Low estrogen levels in female athletes
  • Decreased ligamentous vascularity
  • Genetics
  • Dysmetries

Extrinsic mechanical risk factors:

  • Runners
  • Inadequate footwear
  • Prolonged weight-bearing standing work
  • Flat, pronated or cavus feet
  • Valgus hallux valgus (Bunion)
  • Rapid increases in activity
  • Standing work (standing)

Non-mechanical risk factors

  • Diabetes mellitus
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Chemotherapy
  • Retroviral infections, tuberculosis, Gonococcus

How should it be treated?

The treatment of plantar fasciitis depends on two factors, the time of evolution and the degeneration of the fascia.

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In fasciitis with less than six months of evolution, conservative treatments are used:

  • Personalized podiatric insoles
  • Footwear therapy
  • Stretching and specific exercises
  • Ultrasound-guided injections of hyaluronic acid or corticosteroids.
  • Cryotherapy
  • Activity limitation
  • Physiotherapeutic treatment

In fasciitis of more than 6 months of evolution without degeneration of the fascia, regenerative treatments are used:

  • Regenerative medicine by means of PRP ultrasound-guided infiltrations.
  • Shock waves

In fasciitis of more than 6 months of evolution with degeneration of the fascia the solution is surgical:

  • Ultrasound-guided partial plantar fasciectomy.
  • Spur removal by minimal incision surgery.
  • Radiofrequency of the medial and inferior calcaneal nerve.

What can happen if not treated properly?

If fasciitis is not treated properly during the first 6 months of evolution with conservative treatments, the fascia ends up losing collagen, elastin and water, so it ends up degenerating and it is necessary to resort to surgical treatments.

In the Clínica del Pie Ariño we are specialists in performing this type of minimal incision surgical techniques for the definitive resolution of plantar fasciitis.