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Plantar Fasciitis

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Disease Awareness Page for R3 Stem Cell – Plantar Fasciitis

 

What is plantar fasciitis?

Plantar fasciitis is a condition that affects the connective tissues of the foot. These connective tissues support the arches of the foot and assist in the process of walking. The name plantar fasciitis is a combination of two words: plantar, meaning relating to the foot, and fasciitis meaning inflammation of the fascia. In the past, plantar fasciitis was thought to be due to inflammation of the fascia in the foot, hence the name. However, it has been discovered to be due to other changes in the foot besides inflammation.

Plantar fasciitis involves pain felt at the heel and bottom of the foot. This pain is usually worse when taking the first steps in the morning. It is also aggravated by stretching the foot in an action that points the toe towards the shin. The greater the stretch, the more severe the pain felt. The condition has been associated with several causes, including heel spurs (bony growth on the bone of the heel) and breakdown of the collagen in the foot.

The arches of the foot

The arches of the foot are formed by the small bones that make up the foot, the ligaments, and the tendons in the foot. They are called the arches of the foot because they are responsible for the curved shape the foot takes when it rests on the floor. The arches maintain the body’s balance and support the weight of the body while standing. The ligaments and tendons of the arches make them elastic, meaning they can stretch and contract as needed. 

There are two categories of arches in each foot—the longitudinal arch and the transverse arch—and they are each responsible for different contributions to the foot’s integrity. Any condition that affects any of these arches will cause not only pain and discomfort but also imbalance and an abnormal walking pattern as well.

Plantar fasciitis interferes with normal walking, and individuals who have it are said to have an antalgic gait. This is a condition in which a person limps or walks to avoid bearing weight on the part of the body in a bid to reduce the pain felt.

 

What does the fascia do in the body?

A fascia is a thin and translucent piece of connective tissue that is wrapped around the other connective tissues in the body. The fascia is a bit like a long and elastic piece of plastic wrap. It binds muscles, nerves and blood vessels in portions called tissue compartments. It also offers protection and support to the body. 

When the muscles in these compartments contract, the fascia can expand to accommodate them, and It shrinks when they relax. Problems that could be associated with the fascia, besides plantar fasciitis is compartmental syndrome. In this condition, the pressure in the tissue compartment is higher than normal, and it compresses the nerves and muscles in that compartment, leading to pain. 

The fascia and arches in plantar fasciitis

As mentioned earlier, the prevailing theory in the past was that inflammation of the fascia around the arches of the foot was responsible for the pain and symptoms experienced in plantar fasciitis, but new evidence has come out disproving this theory.

However, the plantar fascia is still affected in this condition because the actions that cause pain like stretching the foot also stretch the fascia. 

What is a walking gait?

Our walking gait is the pattern we use in walking. Even though everyone has the same walking method—left foot; right foot—the way we move specific parts of our bodies differ from each other, and that is what’s unique about our walking gaits. The walking gait is why you can recognize someone from afar off. Even though you haven’t seen their face, you can recognize the way they walk.

What exactly causes plantar fasciitis?  

New studies have observed that microscopic anatomical changes occur in the connective tissues of the foot in plantar fasciitis. This indicates that the symptoms experienced are due to a “structural breakdown” of the plantar fascia. This breakdown is non-inflammatory.

The physical actions that can lead to plantar fasciitis include:

  • Repetitive strain injury to the ligaments and tendons of the feet. These can be caused by excessive walking and running, and wearing ill-fitting shoes 
  • Diseases like arthritis and spondylitis. These diseases cause plantar fasciitis indirectly. Because they cause pain, the individual walks while avoiding putting pressure and load on the source of pain. This imbalance then leads to more stress on some structures than others, and that leads to plantar fasciitis.
  • Calcaneal Spurs. These are small bony growths that shoot out of the heel bone (calcaneus)
  • Breakdown of the collagen in the foot. This is more of a secondary cause and is subject to other primary conditions like repetitive strains.

How common is plantar fasciitis, and who is at risk?

Plantar fasciitis is responsible for most of the occurrences of heel pain. in the heel. It’s is estimated to affect about 0.85% of the population. Also, it is least common in young people (individuals between the age of 18 and 44), with a prevalence of 0.53%. In individuals between 45 and 63 years of age, its occurrence is about 1.33%

The risk factors of plantar fasciitis include:

  • Age: This is thought to be because tissue elasticity reduces with increasing age
  • Diabetes
  • Occupations involving high activity
  • Obesity

What are the symptoms?

The pain involved with plantar fasciitis is usually sharp and one-sided in about 70% of cases. There is:

  • Heel pain, worsened when the individual bears weight, especially after long periods of rest
  • Sharp and intense pain in the morning when taking the first steps
  • Rarer pain patterns include: Tingling, pins and needles, radiating pain, and even numbness

The pain in this condition usually subsides with continuous use of the foot, which is why exercises are so important in its management (more below). 

However, prolonged overuse of the affected area can lead to a rupture of the plantar fascia. This rupture is accompanied by swelling in the foot.

How is plantar fasciitis diagnosed? 

Diagnosing plantar fasciitis is a fairly straight forward task, and can be accomplished by history, assessment of symptoms and physical examination alone. However, a skilful approach is needed since the symptoms are mostly pain without accompanying inflammation. Additionally, numerous conditions present with pain in the feet.

In diagnosing this condition, differentiating between it and other similar conditions is necessary. Some of the other conditions that may resemble plantar fasciitis are:

  • Osteoarthritis 
  • Calcaneal bursitis
  • Stress fractures of the calcaneus (the bone at the heel)

History

History is taken to assess for any risk factors, as well as symptoms that the individual may have experienced. 

Physical assessment

The physical assessment includes checking for pain in the foot while palpating and moving it along the available range of motion. Since the pain in this condition is worsened on stretching of the foot, this is usually one of the signs to look out for.

No imaging scans are necessary to diagnose the condition. However, X-rays and MRIs might be requested to rule out other conditions.

What are the treatment options available? 

Medications

As with other pain-related conditions, medications like Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to manage the pain. Individuals with more severe pain symptoms can benefit from steroidal injections. 

Physical therapy and exercise

Exercises prescribed by a physical therapist can be very effective in the management of plantar fasciitis. The exercises mostly involve stretches of the foot and the underlying structures. Even though the stretches might cause pain, lack of activity can also make them grow worse. Additionally, the stretches can help to relieve tension in the tissues and promote relaxation. This leads to a steady alleviation of symptoms over time.

Shock therapy

In this treatment method, soundwaves are directed at the source of the pain in the foot, and this they interact with the tissues in a way that promotes healing. However, this treatment modality does have side effects that include swelling, bruising, numbness and pain. 

 

Learn More about ongoing clinical studies sponsored by R3 Stem Cell HERE.

 

References

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/diagnosis-treatment/drc-20354851 

https://www.webmd.com/fitness-exercise/treatment-for-plantar-fasciitis#1 

https://www.medicalnewstoday.com/articles/324353.php 

https://www.healthline.com/health/plantar-fasciitis 

Gray, Henry (1918). “7j. Arches of the Foot”. Anatomy of the Human Body. Bartleby.com. ISBN 0-8121-0644-X. Archived from the original on 2009-06-29.

https://www.ncbi.nlm.nih.gov/pubmed/21916393 

https://www.ncbi.nlm.nih.gov/pubmed/23131221 

https://www.ncbi.nlm.nih.gov/m/pubmed/12728038/ 

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