Many professional athletes have had to deal with the plantar fasciitis, an annoying and subtle disorder that forced them to abstain from training and official competitions for days or even weeks. But if you think that this problem is the prerogative of those who practice competitive or amateur physical activity, you are very wrong.
“The plantar fasciaor plantar aponeurosis, is a ligament that draws and supports the arch of the foot, uniting the heel bone, i.e. the calcaneus, with the base of the toes”, intervenes Simone Ripanti, specialist in Orthopedics and Traumatology at the Complex Operational Unit of Orthopedics and Traumatology of the San Giovanni Addolorata Hospital in Rome. «Just like the foundations of a building, this fibrous and elastic tissue supports the foot and, continuously lengthening and shortening during walking or physical exercise, cushions the weight and movements of the body. If the insertion site of this ligament at the heel is subjected to excessive tension, it becomes inflamed and gives rise to plantar fasciitis.”
Plantar fasciitis: what are the causes?
Runners, jumpers, walkers, footballers and tennis players are more likely to suffer from this disorder precisely because their plantar fascia is incessantly stressed. Athletes, therefore, can hardly prevent this inflammatory process; the only thing they can do is try not to wear worn-out sneakers, which can affect the body’s cushioning system.
However, even those who do not do physical activity, or do it occasionally, can run into this problem. «Plantar fasciitis, in fact, can also arise in individuals who, for example personal conformationpresent an exaggerated concavity of the arch, i.e. the so-called cavus foot» continues the orthopedist. «In this case the inflammation is triggered because the support area is limited exclusively to the front part and the heel, which are therefore under pressure more than necessary.
However, there are also predisposing factors obesitywhich weighs on numerous structures of the body including the foot, the use of inappropriate footwear e carrying out tasks that require you to stand for many hours». For these reasons, to keep the disorder at bay, one should try to control one’s body weight, limit the use of shoes with very flat soles, such as ballet flats and flip-flops, or dizzying pumps and occasionally relieve the heel of the body mass , sitting or lying down.
What are the symptoms?
Fasciitis is characterized by a acute painwhich tends to occur after a night’s rest, i.e as soon as you get out of bed and put your foot on the ground. «This painful condition is limited to the heel but, in most cases, the patient is not able to locate the exact painful point because he perceives a widespread, poorly defined, albeit intense, discomfort», confirms the specialist.
«Like all painful manifestations of this nature, also that characteristic of plantar fasciitis improves significantly with heating, that is, continuing to walk. In fact, those who have this disorder almost always report feeling better throughout the day, only to then suffer a worsening again in the evening, when the foot is tired and they finally dedicate themselves to rest. It is no coincidence that many people complain of pain when they start moving again after several hours of immobility, such as after a plane trip or a theater show.”
Even for athletes the mechanism is the same: the pain in the heel area is more pounding in the initial phase of training, then disappears as the activity continues and reappears once training is finished.
Plantar fasciitis: how is the diagnosis made?
Although the patient is not always able to limit the painful site of the foot, the specialist is able, through the palpation e a careful general clinical evaluationto immediately identify the structure involved in the inflammatory process and, therefore, to formulate a diagnosis.
The specialist checks whether there is also a heel spur
The latter can be completed with second level exams, such as a magnetic resonance imagingindicated only in cases where it is necessary to investigate causes of another nature such as nerve crushing, or an x-ray, to verify whether or not a spina calcaneale (o calcaneare). In fact, 20% of individuals with plantar fasciitis develop calcification of the heel, precisely where the fibrous tissue in question is inserted.
«As we have seen, in people most at risk the plantar aponeurosis undergoes excessive traction, forcing the calcaneal bone to “follow” it in its frenetic movements», explains Ripanti. «For its part, the heel, forced to undergo continuous trauma and to stretch to allow the fascia full mobility, responds to this tension by creating a defense spur, neither tangible nor visible to the naked eye because it is protected by the fatty tissue of the heel.”
However, it must be underlined that the pain felt by the patient is caused by the inflammation of the plantar ligament and not by this bony growth, which in itself is totally asymptomatic. This spur, which to all intents and purposes takes on the appearance of a thorn, is formed in all those circumstances in which the heel is subjected to an enormous overload, even where there is no inflammatory process underway, but is not capable of triggering no painful symptoms.
«In the vast majority of cases qThis bony “tail” is harmless and does not cause any problems, so much so that very often you don’t even know you have it”, continues the orthopedist. «Indeed, it happens that some patients undergo an x-ray of their foot for other reasons and realize, in that circumstance, that they have a heel spur. It is, therefore, an occasional radiographic finding, which is discovered almost by chance and left where it is because it does not cause any inconvenience».
How is it treated?
Pharmacological treatment
In 90% of cases, plantar fasciitis, whether or not accompanied by heel spurs, resolves completely with conservative therapy within a few weeks. «To alleviate painful symptoms and reduce ongoing inflammation, we opt, at least initially, for a pharmacological treatment based on painkillers and anti-inflammatories or for local infiltrations with corticosteroids» explains Ripanti.
Physical supports and therapies
«Added to this is the possibility of using a breech support, such as a talloniera in siliconewhich can compensate for the position of the foot and relieve the painful part, or a foot orthosis, to reshape the arch and reduce the load in the most critical area. Even physical therapies, such as tecar not where is urto, have proven to be effective in the treatment of plantar fasciitis because they dampen the inflammatory process and promote ligament regeneration. These treatments must always be associated with stretching exercises, which help to relax the tissues near the heel, including the plantar aponeurosis.”
Athletes must immediately suspend training and competitions at the first signs of plantar fasciitis: ignoring the disorder, suppressing the pain with painkillers, can only worsen the prognosis, jeopardize future treatment and significantly lengthen recovery times. If the pain is very intense, so much so that it prevents correct walking, the patient should not hesitate use crutches to relieve the painful heel.
Surgery
In a very modest percentage of cases – either because the problem has been ignored for a long time or because conservative therapies have proven ineffective – the inflammation can become chronic and the pain can persist for a few months. «For these individuals, who are mainly professional athletes, there is the possibility of performing a surgerywhich aims to eliminate tension and restore the lengthening of the fascia”, concludes the expert.
«With a small incision on the sole of the foot, made under local-regional anesthesia, the insertion site of the calcaneus with the ligament is reached and micro-cuts are made on the latter, in order to loosen the traction. By detaching it slightly from the bone, the fascia relaxes and the pain immediately eases. At the same time, we proceed with the milling of the calcaneal spine, where it is present”.
Stretching exercises
Stretching is a valid ally in combating plantar fasciitis because it helps to relax this ligament, dampening tension in the heel, but also in all other related tissues. The exercises should be performed every day, especially in the morning as soon as you wake up or in the evening before going to bedat least until the painful symptoms disappear.
Raise and lower your toes
Stand (preferably without shoes), keeping your legs at least ten centimeters apart. Gently raise and lower the toes of the painful foot (but, if desired, also of the healthy one) at least ten times.
Grab a handkerchief with your toes
Place a paper towel or napkin under your foot and try to grasp it and lift it with your toes. Release and try again 4-5 times.
Rock on your heels
Bring your body weight onto the balls of your feet and then, with a gentle, floating motion, shift onto your heels. Continue with this undulating motion for at least ten times.
Roll a foot roller under the plant
Slide a foot roller, that is, a cylinder made specifically for plantar stretching, forwards and backwards. In the absence of this tool, a bottle of water is also fine, even better if fresh from the fridge.
It creates tension in the painful foot
Stand facing a wall, one meter away. Place the leg with the painful foot behind the other, until you draw a sort of triangle. He places his hands on the wall and leans his torso forward, so that he feels a slight tension in the hind limb and foot.
Use an elastic band
Sit on the ground, extend the leg with the painful foot like a hammer and bend the other. With an elastic band or a towel, grasp the plant with the fasciitis and, holding the ends, pull towards the body. Hold the position for at least twenty seconds and then release. Repeat 4-5 times.
Lower your heel
Step onto a step with both feet and hold onto the railing. Move the painful foot back, so that the toes are supported and the heel is free. Lower the latter until you feel tension in the calf and hold the position for at least twenty seconds. Repeat 4-5 times.