- Provides comfort and support for plantar fasciitis. Helps alleviate plantar fascia problems due to repeated stress or poor gait.
- Designed with a firm arch plate and deep heel support, these orthotic inserts help stabilize your feet for all-day comfort.
- The arch support and gel heel pad design fit men's 39 to 47 shoes and work with most types of casual shoes.
- In the case of women, it is suitable for shoes from 35 to 41 EU.
Additional information
Plantar fasciitis and bone spur
Plantar fasciitis is the most common cause of lower heel pain. Approximately 2 million patients are treated for this condition each year.
Plantar fasciitis occurs when the strong band of tissue that supports the arch of the foot becomes irritated and inflamed. Plantar fasciitis is defined as a painful retraction of the plantar fascia with an increase in its curvature.
Anatomy
The plantar fascia is a long, thin ligament located directly under the skin on the sole of the foot. It connects the heel to the front of the foot and supports the arch of the foot. It is inelastic and plays an important role in maintaining the arch of the foot during gait and support. The plantar fascia is a thick, strong band that extends from the underside of the heel bone (calcaneus) to the toes, behaving like an extension of the Achilles tendon.
Cause
The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But sometimes too much pressure damages or tears the tissue. The body's natural response to injury is inflammation, which results in heel pain and plantar fasciitis stiffness.
Plantar fascia damage
Too much pressure on the plantar fascia can damage or tear the tissues, causing heel pain.
Risk factors
In most cases, plantar fasciitis develops for no specific, identifiable reason. There are, however, many factors that can make you more prone to the disease:
- Tightened calf muscles make it difficult to flex the foot and bring the toes up toward the shin
- Obesity
- very high arch
- Repetitive impact activity (running / sport)
- New or increased activity
- heel spurs
Although many people with plantar fasciitis have heel spurs, it is not the cause of plantar fasciitis pain. One in 10 people have a spur, but only 1 in 20 people (5%) with a spur have foot pain. Since the spur is not the cause of plantar fasciitis, pain can be treated without removing the spur.
The heel spur does not cause plantar fasciitis pain.
Symptoms
The most common symptoms of plantar fasciitis include:
- Pain in the sole of the foot near the heel
- Pain on first steps after getting out of bed in the morning or after a long period of rest, such as after a long drive. The pain lessens after a few minutes of walking.
- Greater pain after (not during) exercise or activity
Medical exam
After describing your symptoms and discussing your concerns, your doctor will examine your foot. Your doctor will look for these signs:
A high bow
An area of maximum sensitivity on the sole of the foot, just in front of the heel bone
Pain that gets worse when you flex your foot and the doctor pushes the plantar fascia. Pain improves when you point your toes down
Limited "up" movement of the ankle
Tests
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem.
X ray
X-rays provide sharp images of the bones. They are useful for ruling out other causes of heel pain, such as fractures or arthritis. The heel spurs can be seen on an x-ray.
Other Image Tests
Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI can be used if the heel pain is not relieved by initial treatment methods.
Treatment
Non-Surgical Treatment
More than 90% of patients with plantar fasciitis improve within 10 months of starting simple treatment methods.
- Rest. Decreasing or even stopping activities that make pain worse is the first step in reducing pain. You may need to stop athletic activities where your feet hit hard surfaces (for example, running or step aerobics).
- Ice. Rolling your foot over a bottle of cold water or ice for 20 minutes is effective. This can be done 3 to 4 times a day.
- Non-steroidal anti-inflammatory drug. Medicines such as ibuprofen or naproxen reduce pain and inflammation. Medication use for more than 1 month should be reviewed with your primary care physician.
- Exercise. Plantar fasciitis is aggravated by tight muscles in the feet and calves. Stretching the calves and plantar fascia is the most effective way to alleviate the pain that comes with this condition.
Calf stretch
- Lean forward against the wall with one knee straight and your heel on the floor. Place the other leg forward, with the knee bent. To stretch your calf muscles and heel cord, push your hips toward the wall in a controlled manner. Hold for 10 seconds and relax. Repeat this exercise 20 times for each foot. Strong traction on the calf should be felt during the stretch.
- Elongation of the plantar fascia
- This stretch is performed in a sitting position. Cross the affected foot over the knee of the other leg. Grasp your aching toes and slowly pull them toward you in a controlled manner. If your foot is difficult to reach, wrap a towel around your big toe to help pull it toward you. Place your other hand along the plantar fascia. The fascia should look like a tight band along the sole of the foot when stretched. Keep stretching for 10 seconds. Repeat 20 times for each foot. This exercise is best done in the morning, before standing or walking.
Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory drug. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to flat feet and chronic pain.
Support shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain when standing and walking. As you take a step and your heel hits the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (small tears in the tissue). A padded shoe or insole reduces this tension and the microtrauma that occurs with each step. Soft silicone heels are inexpensive and work by lifting and cushioning the heel. Pre-made or custom orthotics (shoe inserts) are also useful.
To heel
The soft heel pads can provide extra support like the plantar fasciaairplus orthotic insoles.
- Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint lengthens the plantar fascia while you sleep. Although it can be difficult to sleep, a night splint is very effective and doesn't need to be used once the pain is gone.
- Physiotherapy. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like those mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medications to decrease inflammation around the plantar fascia.
Extracorporeal shock wave therapy (ESWT). During this procedure, high-energy shock wave impulses stimulate the healing process in the damaged plantar fascia tissue. ESWT has not shown consistent results and therefore is not commonly performed.
ESWT is non-invasive - it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes attempted before surgery is considered.
Surgical treatment
Surgery is considered only after 12 months of aggressive non-surgical treatment.
- Gastrocnemius recession. This is a surgical stretch of the calf muscles (gastrocnemius). Because the tight calf muscles put pressure on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet despite a year of calf stretches.
In gastrocnemius recession, one of the two muscles that make up the calf is stretched to increase ankle movement. The procedure can be performed with a traditional open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best suits your needs.
Complication rates from gastrocnemius recession are low, but can include nerve damage.
- Release of the plantar fascia. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the ligament of the plantar fascia is partially cut to relieve tension in the tissue. If you have a large bone spur, it will also be removed. Although surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy poses an increased risk of nerve damage.
- Complications. The most common complications of release surgery include incomplete pain relief and nerve damage.
Recovery.
Most patients have good results with surgery. However, as surgery can result in chronic pain and dissatisfaction, it is only recommended after all non-surgical measures have been exhausted.
Prevention
Warming up before starting any sporting activity is essential. It is equally important to maintain adequate levels of activity without overexertion or overload.
Maintaining a healthy weight helps reduce pressure on your heels.
