Plantar fasciitis is caused by strain on the soles of the feet due to external force or prolonged walking or exercise, leading to localized muscle strain and aseptic inflammation of the tendons or fascia. The most common symptoms are heel pain and discomfort. With active treatment, the prognosis is generally good, but delayed treatment may affect normal walking and exercise. Some patients may experience relapses after treatment.
Clinical classification
Plantar fasciitis is divided into traumatic plantar fasciitis and non-traumatic plantar fasciitis. Traumatic plantar fasciitis is further divided into acute plantar fasciitis and chronic fasciitis.
Epidemiology
Contagious
The disease is not contagious.
Incidence
Approximately 10% of the general population suffers from plantar fasciitis.
High-risk population
1. The incidence rate is higher among people aged 40 to 60 years old, and more in women than in men.
2. Athletes, dancers, teachers and other people who have to stand, run or walk for long periods of time.
Causes
Overview
The specific cause of plantar fasciitis remains unclear, but it may be related to adverse external stimuli such as cold and humid climates, chronic strain, trauma, and immune factors. Long-term excessive stress can cause acute or chronic damage to the plantar fascia. Prolonged, excessive hiking, running, and mountaineering can also lead to plantar fasciitis. Structural abnormalities of the foot, such as flat feet, knock feet, and a shortened Achilles tendon, can also contribute to improper foot support during walking.
Risk factors
1. Age
Plantar fasciitis is most common in people between the ages of 40 and 60.
2. Occupation
Traffic police, teachers, dancers, and long-distance runners are at higher risk of developing the disease.
3. Others
Obese people will exert greater pressure on the soles of the feet; endocrine factors such as diabetes will also increase the risk of disease.
symptom
Overview
Patients with plantar fasciitis generally experience symptoms such as pain, muscle tension, and muscle spasms near the heel or arch of the foot. Some patients also experience pain in the forefoot. Severe cases may experience movement disorders and abnormal walking posture.
Typical symptoms
The main symptoms of plantar fasciitis are pain and discomfort in the heel after getting out of bed, running, walking again after running, or resting. The pain can be relieved by itself after activity, but the pain will worsen again after walking for a long time or more strenuous activities, and even a pricking pain will radiate to the front of the foot.
complication
If plantar fasciitis is not treated promptly, movement disorders may occur and walking posture may be affected.
examine
Scheduled inspection
Patients experiencing heel pain, muscle tension or cramps, skin numbness, or movement disorders should seek medical attention promptly. Doctors will perform a physical examination and, depending on the patient’s condition, may also order blood tests, blood biochemistry, erythrocyte sedimentation rate (ESR), and magnetic resonance imaging (MRI) to confirm the diagnosis.
Physical examination
The doctor will carefully examine the patient’s painful area to check whether there are nodules or cord-like lumps in the painful area; the doctor may press the patient’s heel or massage the sole of the foot to observe whether there is tenderness.
Laboratory tests
Complete blood count, blood chemistry, erythrocyte sedimentation rate (ESR), C-reactive protein, and other immunological tests may be necessary to determine if the pain is caused by immune factors or to exclude infectious diseases. Most tests are within normal ranges, but anti-O and ESCR may be elevated.
Imaging examinations
1. X-ray
X-ray examinations can check for bone problems on the patient’s soles, and may reveal osteophytes (bone spurs). Bone spurs may occur due to long-term stretching of the plantar fascia.
2. Magnetic resonance imaging (MRI)
Myofascia is soft tissue, and MRI provides excellent contrast for soft tissue, demonstrating soft tissue lesions. MRI can also help exclude and differentiate other diseases. Localized exudates may demonstrate long T1 and long T2 signals , appearing as strips with clear boundaries.
diagnosis
Diagnostic principles
Doctors can make a diagnosis based on the patient’s medical history, combined with their heel pain and discomfort, clinical manifestations and signs that worsen in the morning and after strenuous activity, and referring to the results of X-rays and MRI examinations.
Differential diagnosis
1. Calcaneus compression fracture
Calcaneal fractures primarily present with severe heel pain, accompanied by significant swelling and bruising, inability to walk with the heel touching the ground, and calcaneal tenderness, similar to the clinical presentation of plantar fasciitis. X-rays can be used to differentiate calcaneal fractures, as they show destruction of the calcaneal trabeculae.
2. Inflammation or atrophy of the plantar fat pad
The plantar fat pad is a patch of fat tissue beneath the heel bone. With aging, the heel fat pad gradually dehydrates and loses collagen, causing it to shrink and thin. Symptoms of plantar fat pad inflammation are similar to those of plantar fasciitis, both of which cause pain on the sole of the foot. X-rays can be used to measure the thickness of the plantar fat pad and differentiate between these two conditions.
treat
Treatment principles
Plantar fasciitis is usually treated with non-surgical treatments, such as medication, physical therapy, exercise therapy, closed therapy, etc. Surgical treatment may be considered for a very small number of patients who fail non-surgical treatments.
Drug treatment
1. Local treatment
Doctors often use procaine for local pain point blockade treatment, and prednisolone acetate can be added.
2. Systemic treatment
(1) Non-steroidal analgesic and anti-inflammatory drugs: They are usually the first choice and can reduce local inflammation and relieve pain. Celecoxib, ibuprofen sustained-release capsules, or diclofenac sodium sustained-release tablets can be used.
(2) Antispasmodic drugs: Patients with local muscle tension and pain can use eperisone hydrochloride, etc.
Related drugs
Procaine, prednisolone acetate, celecoxib, ibuprofen extended-release capsules, diclofenac sodium extended-release tablets, eperisone hydrochloride
Surgical treatment
A very small number of patients who have not been cured after prolonged treatment can undergo surgery. Minimally invasive procedures, such as ultrasound-guided acupuncture or radiofrequency therapy, are effective for releasing muscle fascia. Open surgery to remove the diseased tissue is also an option, but the indications for surgery should be carefully considered.
physical therapy
1. Wearing functional orthotic insoles is the primary method of physical therapy. They can be worn during daily walking and exercise. Functional orthotic insoles are tailored to each individual’s unique plantar morphology and the unique physiological curvature of the arch. They evenly distribute pressure from the sole of the foot during walking or exercise, thereby relaxing the plantar muscles, reducing tension in the plantar fascia, and promoting the dissipation and absorption of inflammation, thereby alleviating pain and restoring normal function.
2. Doctors also often use infrared, microwave, extracorporeal ultrasound and other methods to treat patients.
Other treatments
1. Extracorporeal shock wave therapy
This treatment uses shock waves to target the painful area, reducing tissue edema, lowering tension in the plantar fascia, and repairing degenerative tissue to a certain extent, thereby relieving pain. Side effects may include bruising, swelling, pain, and numbness.
2. Platelet-rich plasma (PRP) injection therapy
Platelet-rich plasma is injected into the thickened area of the plantar fascia under ultrasound guidance. Because PRP contains growth factors and other proteins, it can promote the repair of the plantar fascia and improve pain symptoms.
Treatment cycle
Individual differences may exist due to factors such as the severity of the disease, treatment plan, treatment timing, and personal constitution.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
Plantar fasciitis is a slowly progressive disease that can gradually affect a patient’s quality of life. With timely intervention and treatment, most patients have a good prognosis. However, some patients may develop a chronic condition that persists.
Hazards
1. If plantar fasciitis is not treated in time, it may affect the patient’s normal walking and exercise.
2. Long-term pain will have a certain impact on the patient’s psychology.
Self-healing
Symptoms of this disease may resolve on their own.
Curative
After active treatment, the symptoms of most patients can disappear and will not affect their normal life.
Cure rate
There is no large sample data research yet.
Radical
Some patients with plantar fasciitis can be cured through rest or treatment.
Recurrent
Some patients may relapse.
daily
Overview
Patients must get more rest in their daily lives, keep their body and mind happy, reduce strenuous exercise, use medications reasonably, and have regular check-ups.
Psychological care
1. Psychological characteristics
Plantar fasciitis progresses slowly, has a long course, and may relapse, causing patients to feel anxious.
2. Nursing measures
Patients can proactively consult medical staff about their prognosis and communicate more with recovered patients to increase their confidence in recovery. Family members need to understand the pain patients suffer from the disease and accompany them in foot muscle stretching exercises to promote their recovery.
Medication care
Take medications as directed by your doctor, do not increase or decrease the dosage on your own, and never take medications on your own. Read the medication instructions carefully to understand the indications, contraindications, and adverse reactions.
Life Management
1. Live a regular life, pay attention to rest, avoid staying up late, sleep on a hard bed, and avoid heavy physical labor or strenuous exercise.
2. You can soak your feet in hot water every night and massage the soles of your feet appropriately, but the water temperature should not be too high (not more than 40 degrees Celsius).
3. Adhere to functional exercises, pay attention to the combination of movement and stillness, be careful to proceed step by step, and avoid forced activities.
4. Pay attention to your working posture in life and work, do not carry excessive weight, and avoid standing for long periods of time.
5. Keep warm and avoid staying in a damp or cold environment for a long time.
6. Obese patients can perform scientific exercises and lose weight to reduce pressure on the soles of their feet.
Disease monitoring
Because plantar fasciitis can recur, patients need to seek medical attention promptly if they experience heel pain and discomfort again.
diet
Dietary adjustment
There are generally no special dietary requirements for plantar fasciitis. Just ensure that the nutrition is rich and balanced. Avoid eating spicy and greasy foods, and avoid smoking and drinking.
Dietary recommendations
1. Eat a balanced diet and eat more calcium-rich foods.
2. Eat more fresh fruits and vegetables to keep bowel movements smooth.
3. Eat more high-quality protein foods, such as fish, chicken breast, etc.
Dietary taboos
1. Avoid eating spicy and greasy foods, and eat less pickled foods.
2. Avoid smoking and drinking.
prevention
Preventive measures
You can prevent plantar fasciitis by managing your daily life. The details are as follows:
1. Pay attention to safety and avoid external injuries.
2. Pay attention to climate changes, take good warming measures, and prevent cold and dampness.
3. Do not stand for a long time and do not overexert yourself.
4. Exercise moderately regularly. Warm up before physical exercise and increase the intensity gradually. After professional training or high-intensity exercise, you also need to relax your foot muscles.
5. People who are too obese should pay attention to losing weight and controlling their weight to reduce the burden on their muscles.
Medical Guide
Outpatient indications
When symptoms such as pain, muscle tension or movement disorders occur in the soles of the feet, you should seek medical treatment promptly.
Treatment department
Patients are generally recommended to go to orthopedics or general surgery for diagnosis and treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
3. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
4. Family members can be arranged to accompany the patient to seek medical treatment.
5. Prepare a list of questions you want to ask in advance.
Questions your doctor may ask
1. What symptoms do you have? How long have you had them?
2. Does the pain occur at a specific time? When is it most severe?
3. Since the onset of pain, what factors have aggravated or relieved the pain?
4. Do you usually exercise? What do you mainly do?
5. What is your occupation? Does it require you to walk or stand for long periods of time?
6. Have you ever experienced a similar situation before? How did you treat it?
What questions can patients ask?
1. What is my condition? Is it serious? Will it cause disability?
2. What causes this disease?
3. What tests are needed to confirm the diagnosis?
4. Will the symptoms persist? Will they recur?
5. What treatment options are recommended? Is surgery necessary?
6. Are there any risks during the treatment process?
7. How long does it take to heal?
8. What should we pay attention to in daily life?
9. Can I exercise and work normally?