Plantar fasciitis

Overview of Plantar fasciitis

Plantar fasciitis (heel pain) is now a common problem among people. In gender ratio, it occurs in women more than men.

This occurs when the plantar fascia gets inflamed due to over stress.[2]

The pain originates at or near the site of the plantar fascia attachment to the medial tuberosity of calcaneus.

Epidemiology

Unfortunately, there is limited specific Indian epidemiological data on plantar fasciitis readily available in published literature. Most studies on plantar fasciitis prevalence and risk factors are conducted in Western populations. However, based on some relevant Indian studies, here are a few points:

• Prevalence: One study estimated that plantar fasciitis accounts for 11-15% of all foot symptoms requiring professional medical care in India (Menon & Jain, 2018).

• Risk Factors: Indian research suggests potential risk factors for plantar fasciitis in the Indian population include:

  • Obesity: One study found a higher prevalence of plantar fasciitis among individuals with a BMI over 30 (Choudhary et al., 2024).
  • Occupation: Occupations involving prolonged standing or walking on hard surfaces are associated with an increased risk (Menon & Jain, 2018).
  • Footwear: Inappropriate footwear, especially in women, can contribute to plantar fasciitis development (Menon & Jain, 2018).

References:

• Menon, N. A., & Jain, J. (2018). Plantar fasciitis: A review. Indian Journal of Pain, 32(2), 24-30. [5]
• Choudhary, J., Pandit, A., & Hatmode, Y. (2024). The prevalence and risk factors of plantar fasciitis amongst the 40 years above population. Indian Journal of Applied Research, 14(6). [6]

Causes of Planter fasciitis

Too much pressure and stretching damages, inflames or tears your plantar fascia.

Unfortunately, there’s no discernable cause for some cases. However, you’re more likely to get plantar fasciitis if:

• You have high-arched feet or flat feet.
• You wear shoes that don’t support your feet (especially for a long time on a hard surface).
• You’re higher-weight person. (70% of patients with plantar fasciitis are also higher-weight person.)
• You’re an athlete.
• You’re a runner or jumper.
• You work or exercise on a hard surface.
• You stand for prolonged periods of time.
• You exercise without stretching your calves.[4]

Risk factor of Plantar fasciitis

Several factors that increase the risk of developing plantar fasciitis include

• Obesity,
• Pes planus (Flat foot or absence of foot arch when standing),
• Pes cavus (high arched foot),
• Limited dorsiflexion of the ankle,
• Prolonged standing,
• Walking on hard surface and faulty shoes.

In runners, excessive running and a change to a harder running surface may precipitate plantar fasciitis.[1]

Pathogenesis

The pathogenesis of plantar fasciitis is best described as a degenerative process involving repetitive microtrauma and inflammation of the plantar fascia. The exact cause remains elusive, but the current understanding points towards several factors:

• Repetitive Microtrauma: Overuse and excessive stress on the plantar fascia, particularly at its insertion on the calcaneus (heel bone), lead to microscopic tears and damage.
• Inflammation: The body responds to this injury with an inflammatory response, aimed at healing the damaged tissue. However, chronic inflammation can perpetuate the cycle of tissue damage and pain.
• Degeneration: Over time, the repeated microtrauma and inflammation result in degenerative changes within the plantar fascia, including thickening, collagen disorganization, and decreased elasticity.
• Calcification: In some cases, calcium deposits may form within the plantar fascia, further contributing to pain and stiffness.[7]

Pathophysiology of Plantar fasciitis

The plantar fascia is a thick flat band of tissue (ligament) that originate from the heel bone to the base of toes.

It supports the arch of your foot. Actually, the plantar fasciitis as it is named is not an inflammatory condition of plantar fascia.

It is a non-inflammatory micro tear of the fascia result from over stress on its surface.

There is also calcification of fibrous tissues of plantar fascia. [2]

Types

While plantar fasciitis itself is a specific condition, it can be broadly classified into two main types based on its duration and onset:

1. Acute Plantar Fasciitis: This type typically arises suddenly, often due to a specific injury or overuse. It’s characterized by sharp pain and inflammation at the heel, particularly in the morning or after periods of rest.

2. Chronic Plantar Fasciitis: This type develops gradually over time, often due to repetitive stress and microtrauma to the plantar fascia. The pain is usually more persistent and dull, and may worsen with activity or prolonged standing.

Additionally, plantar fasciitis can be further categorized based on the location of the pain:

• Insertional Plantar Fasciitis: Pain is primarily located at the insertion of the plantar fascia on the heel bone (calcaneus).
• Non-insertional Plantar Fasciitis: Pain is felt along the arch of the foot, away from the heel bone. [8]

Clinical Features

The clinical features of plantar fasciitis are typically characterized by:

• Heel Pain: The hallmark symptom is pain in the heel, usually localized to the medial aspect (inner side) of the heel.
• Morning Pain: The pain is often most severe in the morning upon taking the first few steps after getting out of bed. This is due to the plantar fascia tightening overnight.
• Pain After Rest: Similar to morning pain, discomfort may also increase after sitting or resting for a prolonged period.
• Pain with Activity: Pain may worsen with activities that involve weight-bearing, such as walking, running, or standing for extended periods.
• Tenderness: There is often tenderness to palpation (touch) at the origin of the plantar fascia on the heel bone. [9]

Sign & Symptoms :

Both a dull pain and a stabbing pain have been reported by patients with plantar fasciitis. The symptoms of plantar fasciitis include:

• Pain on the bottom of the heel, or nearby.
• Increased pain after exercise (not during).
• Pain in the arch of the foot.
• Pain that is worse in the morning or when you stand after sitting for a long time.
• A swollen heel.
• Pain that continues for months.
• A tight Achilles tendon.
• Your Achilles tendon connects your calf muscles to your heel.[4]

Clinical Examination

The clinical examination for plantar fasciitis typically involves several key components:

• History Taking: The physician will inquire about the patient’s symptoms, including the location, duration, and severity of pain, as well as any aggravating or relieving factors. They will also ask about the patient’s medical history, occupation, and activities to identify potential risk factors.
• Observation: The physician will observe the patient’s foot posture, gait, and any visible abnormalities, such as swelling, redness, or bruising.
• Palpation: The physician will gently palpate the heel and plantar fascia to identify areas of tenderness or thickening. This often elicits pain at the medial calcaneal tubercle, the insertion point of the plantar fascia.
• Range of Motion: The physician will assess the range of motion of the ankle and foot joints, which may be limited due to pain or tightness in the plantar fascia.
• Windlass Test: This test involves passively dorsiflexing the big toe while the patient is weight-bearing. A positive test reproduces pain along the plantar fascia, indicating plantar fasciitis. [10]

Diagnosis of Plantar fasciitis

• The diagnosis of plantar fasciitis can usually made on the basis of history and physical examination alone.
• Patients experience severe pain with  the first steps on arising in the morning or following inactivity during the day.
• The pain  usually lessens    with weight-bearing activity during  the day,  only to worsen with continued activity.
• Pain make  worse on  walking barefoot  or On examination, maximal tenderness elicit on palpation over the inferior heel corresponding to the site of attachment  of the plantar fascia.
• Plain radiography shows heel spurs, Ultrasonography shows thickening of the fascia and diffuse hypo echogenicity, indicating edema at the attachment of the plantar fascia to the calcaneus.
• MRI is a sensitive method for detecting plantar fasciitis, but it is usually not require for establishing the diagnosis.[1]

Differential Diagnosis of Plantar fasciitis

• Calcaneal stress fractures
• The spondylarthrosis, rheumatoid arthritis
• Neoplastic or infiltrative bone  processes
• Nerve compression, entrapment syndromes

Complications

While plantar fasciitis itself is a painful and often debilitating condition, if left untreated or improperly managed, it can lead to further complications:

1. Chronic Heel Pain: Persistent pain can significantly impact daily life, limiting activities and reducing quality of life.
2. Plantar Fascia Rupture: In rare cases, the plantar fascia may rupture completely, often resulting in a sudden sharp pain and a popping sensation. This usually requires surgical intervention.
3. Heel Spur Formation: Chronic inflammation can lead to the formation of a bony growth (heel spur) on the heel bone, which can cause additional pain and discomfort.
4. Gait Abnormalities: To avoid pain, individuals may alter their gait, which can place additional stress on other parts of the foot, ankle, knee, hip, or back, leading to further injuries.
5. Nerve Entrapment: In some cases, inflammation can irritate nearby nerves, leading to numbness or tingling in the foot. [11]

Investigations

• Plain radiography shows heel spurs, Ultrasonography shows thickening of the fascia and diffuse hypo echogenicity, indicating edema at the attachment of the plantar fascia to the calcaneus.
• MRI is a sensitive method for detecting plantar fasciitis, but it is usually not require for establishing the diagnosis.[1]

Treatment of Plantar fasciitis

Resolution of  symptoms occur within  12 months in more than  80% of  patients with plantar fasciitis.

• The patient is  advised to reduce or discontinue activities that can exacerbate plantar.
• Initial treatment consists of ice, heat, massage and stretching.
• Orthotics provide medial arch support and can be effective.
• Foot strapping or taping are  commonly performed and some patients may benefit by wearing  a night splint designed to keep the ankle  in a neutral position.
• A short course  of NSAIDs can be given to patients when the benefits outweigh the risks.
• Local glucocorticoid injections have also been shown to be efficacious but may carry an increased  risk for plantar fascia Plantar fasciotomy is reserved for those  patients who have failed to improve after  at  least  6–12 months of conservative treatment.[1]

Prevention

Preventing plantar fasciitis involves a combination of lifestyle modifications, proper footwear, and targeted exercises:

• Maintain a Healthy Weight: Excess weight places additional stress on the plantar fascia, increasing the risk of injury. Maintaining a healthy weight through diet and exercise can help reduce this risk.
• Choose Supportive Footwear: Wear shoes with good arch support and cushioning, especially during activities that involve prolonged standing or walking. Avoid high heels and flat shoes that offer minimal support.
• Stretch Regularly: Stretching the calf muscles and plantar fascia can improve flexibility and reduce tension, helping to prevent microtrauma. Perform stretches like the calf stretch, plantar fascia stretch, and towel stretch regularly.
• Strengthen Foot Muscles: Strengthening exercises like toe curls, marble pickups, and resistance band exercises can help improve foot arch stability and reduce stress on the plantar fascia.
• Avoid Overuse: Gradually increase the intensity and duration of physical activities, and avoid sudden increases in mileage or training. Listen to your body and rest when needed.
• Use Orthotics: If you have flat feet or other structural abnormalities, custom orthotics can provide additional arch support and help distribute pressure more evenly across the foot. [8]

Homeopathic Treatment 

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Plantar fasciitis

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Berberis Vulgaris

• Excellent among Homeopathic medicines for plantar fasciitis where heel pain worsens on standing
• Berberis Vulgaris is one of the most effective Homeopathic medicines for plantar fasciitis where standing worsens heel pain.
• Few persons needing Berberis Vulgaris may specifically complain of ulcerative pain in the heel.
• Pain in balls of feet on stepping is yet another indication to use Berberis Vulgaris. 

Bryonia Alba

• One of the best Homeopathic medicines especially for plantar fasciitis where heel pain worsens from stepping
• Moreover, Bryonia Alba is one of the most suitable Homeopathic medicines for plantar fasciitis where the heel pain worsens from stepping. Rest brings relief.
• Pins also needle-like sensation in soles may accompany the heel pain in some cases.[3]

Rhus Tox

• Rhus Tox one of the best rate Homeopathic medicines for plantar fasciitis.
• Rhus Tox prominently indicate for complaints arising from excessive stress, strain on or use of a body part.
• In cases where heel pain is worse specifically in the mornings as one takes the first few steps, Rhus Tox is the Homeopathic medicine for plantar fasciitis.
• The heel pain subsides eventually.
• Apart from the above unique symptom, Homeopathic medicine Rhus Tox is also considered for plantar fasciitis cases where running and exercise worsen the pain by putting excessive stress on the heels.[3] 

Pulsatilla Nigricans 

• One of the most wonderful Homeopathic medicines for plantar fasciitis where heel pain worsens from rising from seat.
• For heel pain that worsens when rising from a sitting position.
• Pulsatilla Nigricans consider one of the best Homeopathic medicines for plantar fasciitis.
• Boring pain in the heel that worsens in the evening is another unique symptom that signals use of Pulsatilla Nigricans as the ideal choice among Homeopathic medicines for plantar fasciitis.
• Pulsatilla Nigricans is also helpful for heel pain that comes on every time one starts walking.
• Such persons feel the need to stretch their feet.[3]

Valeriana Officinalis 

• Well indicated among Homeopathic medicines for plantar fasciitis where heel pain gets better by walking.
• Valeriana Officinalis is another of the well-recognized Homeopathic medicines for plantar fasciitis treatment.
• Valeriana Officinalis is well indicated for plantar fasciitis where the heel pain gets better by walking.
• Sitting worsens the heel pain.

Diet & Regimen

• Try to avoid prolonged standing posture on any hard surface.
• In case of women, they usually do cook and other household work standing for a long period.
• In this case it is advisable not to stand for a long period and take a break every few minutes.
• Otherwise, they can use silicon pads inside the shoes. Though in our tradition shoes not allowed inside the kitchen, but a silicon pad packed shoe can be kept only for using inside kitchen.
• To relieve pain, you can apply both ice and warm application alternately.
• Keep two tubs, one tub filled with cold water & the other one filled with warm water. Dip your foot first in warm water tub for 1 to 2 minutes, then remove out and put in cold water tub for 1-2 minutes. Do it 5 to 6 times daily before going to bed.[2]
• Some exercises to relieve pain:

Toe exercise– Sit in a chair, and extend your affected leg so that your heel is on the floor. With your hand pull your big toe up and back. Pull toward your ankle and away from the floor. Hold the position for at least 15 to 30 seconds. Repeat 2 to 4 times a session, several times a day.

Towel stretch– Place a rolled towel under the ball of your foot, holding the towel at both ends. Gently pull the towel toward you while keeping your knee straight. Hold this position for 15 to 30 seconds.[2]

Do’s & Don’ts

Plantar Fasciitis do’s & don’ts 

Do’s

• Do rest your feet: Reduce activities that exacerbate pain, particularly those involving prolonged standing or impact.
• Do apply ice: Apply ice packs to the affected heel for 15-20 minutes several times a day to reduce inflammation and pain.
• Do stretch regularly: Perform gentle stretches for your calf muscles and plantar fascia, especially in the morning and before/after activities.
• Do wear supportive shoes: Opt for shoes with good arch support and cushioning to reduce stress on the plantar fascia. Avoid high heels and worn-out shoes.
• Do consider orthotics: Custom or over-the-counter orthotics can provide additional arch support and help correct foot mechanics.
• Do consult a healthcare professional: Seek professional advice for diagnosis, treatment recommendations, and ongoing management of plantar fasciitis.
• Do maintain a healthy weight: Excess weight puts additional strain on the plantar fascia. Maintaining a healthy weight can help reduce this stress.

Don’ts

• Don’t ignore the pain: Ignoring or pushing through pain can worsen the condition and delay healing.
• Don’t walk barefoot on hard surfaces: This can increase stress on the plantar fascia. Wear supportive footwear even indoors.
• Don’t wear high heels: High heels put excessive strain on the plantar fascia and can exacerbate pain.
• Don’t engage in high-impact activities: Avoid activities like running, jumping, or other exercises that put a lot of stress on your feet until the condition improves.
• Don’t self-diagnose: Many conditions can cause heel pain. Consult a healthcare professional for an accurate diagnosis and treatment plan.
• Don’t expect overnight results: Plantar fasciitis treatment takes time. Be patient and consistent with your treatment plan.

Terminology

Anatomical Terms

• Plantar Fascia: A thick band of connective tissue that runs along the bottom of the foot, from the heel to the toes. It supports the arch of the foot and acts as a shock absorber during walking and running.
• Calcaneus: The heel bone, the largest bone in the foot.
• Medial Calcaneal Tubercle: The bony prominence on the inner side of the heel bone where the plantar fascia attaches.
• Aponeurosis: A flat, sheet-like tendon that attaches muscle to bone or other tissues. The plantar fascia is sometimes referred to as the plantar aponeurosis.

Medical Terms

• Inflammation: A localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection.

• Microtrauma: Tiny, often microscopic, injuries to tissues caused by repetitive stress or overuse.
• Degeneration: The deterioration or breakdown of tissues due to aging, injury, or disease.
• Calcification: The process of calcium salts being deposited in tissues, leading to hardening or stiffening.
• Heel Spur: A bony growth that can develop on the heel bone, often associated with plantar fasciitis.

Other Terms

• First-Step Pain: The characteristic sharp pain experienced in the heel upon taking the first few steps in the morning or after a period of rest.
• Windlass Mechanism: The tightening of the plantar fascia during toe extension, which helps maintain the arch of the foot.
• Overpronation: The excessive inward rolling of the foot during walking or running, which can put extra strain on the plantar fascia.
• Orthotics: Custom-made shoe inserts that provide support and correct foot alignment.
• Night Splints: Devices worn at night to keep the foot in a stretched position, which can help reduce morning pain.

Commonly Used Homeopathic Remedies for Plantar Fasciitis:

• Ruta Graveolens: Often recommended for heel pain and stiffness, particularly when aggravated by rest and relieved by movement.
• Rhus Toxicodendron: Commonly used for pain and stiffness that worsen with initial movement but improve with continued activity.
• Arnica Montana: May be helpful for pain and inflammation associated with injury or overuse.
• Bryonia Alba: Often indicated for sharp, stitching pains that worsen with movement and improve with rest and pressure.
• Calcarea Fluorica: Can be considered for heel spurs or bony growths associated with plantar fasciitis.

References

use for Article Planter fasciitis

1. Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Set
2.  https://www.practo.com/healthfeed/homeopathy-treatment-for-heel -pain-plantar-fasciitis-12726/post
3. https://www.drhomeo.com/homeopathic-treatment/homeopathic-medicines-for-plantar-fasciitis/
4. https://my.clevelandclinic.org
5. Menon, N. A., & Jain, J. (2018). Plantar fasciitis: A review. Indian Journal of Pain, 32(2), 24-30.
6. Choudhary, J., Pandit, A., & Hatmode, Y. (2024). The prevalence and risk factors of plantar fasciitis amongst the 40 years above population. Indian Journal of Applied Research, 14(6).
7. Campbell’s Operative Orthopaedics (2020), 14th Edition, by S. Terry Canale, James H. Beaty. Published by Elsevier.
8. Foot and Ankle Disorders (2014), 3rd Edition by Mark S. Myerson. Published by Elsevier.
9. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (2017), 14th Edition. by Janice L. Hinkle, Kerry H. Cheever. Published by Wolters Kluwer
10. Essential Orthopaedics and Trauma (2019), 6th Edition, by David J. Dandy, Nicholas D. Clement. Published by Elsevier.
11. Foot and Ankle Sports Injuries (2018), 3rd Edition, by Jay Hertel, Timothy A. McGuine. Published by Wolters Kluwer.

Also Search As

People can search for homeopathic articles on Plantar Fasciitis using a variety of methods and search terms. Here are some effective ways:

Search Engines:

Specific Keywords:

Use precise search terms like:

"homeopathic treatment for plantar fasciitis"

"plantar fasciitis homeopathy remedies"

"homeopathic medicine for heel pain"

"homeopathic approach to plantar fasciitis"

Include Symptoms:

Add specific symptoms for targeted results:

"homeopathy for heel pain in the morning"

"homeopathic remedies for heel spurs"

"homeopathy for plantar fasciitis and flat feet"

Search within Homeopathic Websites:

Directly search within websites of homeopathic clinics, practitioners, or organizations.

Homeopathic Resources:

Homeopathic Forums & Communities:

Participate in online forums and communities dedicated to homeopathy to ask questions and learn from others’ experiences.

Homeopathic Journals & Publications:

Search databases or websites of homeopathic journals and publications for research articles and case studies.

Consult a Homeopathic Practitioner:

Discuss your specific concerns and symptoms with a qualified homeopath for personalized treatment and recommendations.

Other ways

There are numerous ways to search for information about plantar fasciitis online, each offering different depths of knowledge and perspectives. Here’s a breakdown of some common search methods:

1. Search Engines (Google, Bing, etc.):

Basic Search: Start with simple keywords like "plantar fasciitis" or "heel pain" to get a general overview.

Specific Queries: Refine your search with questions like:

"What are the symptoms of plantar fasciitis?"

"Best exercises for plantar fasciitis"

"Plantar fasciitis treatment options"

Use Image Search: Search for visuals of the condition, treatment techniques, or exercises.

Medical Websites & Databases:

Reputable Sources: Look for websites ending in .gov, .edu, or .org (e.g., Mayo Clinic, WebMD, NIH).

Medical Journals: Search databases like PubMed for scholarly articles on plantar fasciitis research and treatment.

• Social Media & Online Communities:

Hashtags: Search relevant hashtags like #plantarfasciitis on platforms like Instagram, Twitter, or Facebook.

Support Groups: Join online forums or groups for people with plantar fasciitis to share experiences and advice.

Health Apps & Trackers:

Symptom Trackers: Log your symptoms and progress over time to help identify triggers and track your recovery.

Exercise & Stretching Apps: Find apps with guided routines specifically for plantar fasciitis.

• Local Resources:

Doctor’s Website: Check your doctor’s website or patient portal for educational resources.

Local Health Clinics: See if nearby clinics or hospitals offer online resources or classes on plantar fasciitis.