In this article, we take a detailed look at the symptoms, treatments, and cures for plantar fasciitis:
The plantar fascia (also known as the arcuate ligament) is a fibrous band that plays an extremely important role in supporting the body's weight when standing upright.
It connects the heel bone (calcaneus) to the base of the toes (metatarsals).
When standing, walking, or running, the entire body weight is distributed between these two structures through the plantar fascia, which therefore undergoes significant stress.
In particular, when the heel lifts off the ground and the entire body weight is supported by the metatarsals — as happens, for example, during running — the stress on the plantar arch increases even more.
Plantar fasciitis is the inflammation of the plantar fascia (also known as the arcuate ligament) and is the most common cause of pain in the sole of the foot or under the foot. Approximately four out of five people who experience heel pain are affected by this condition.
The main symptom of plantar fasciitis is, of course, pain.
This pain can be localized at the back of the heel (known as insertional plantar fasciitis) or can radiate toward the toes.
It is typically described as a burning pain, worsened by walking—especially with each heel strike on the ground.
The pain caused by plantar fasciitis is most intense:
Plantar fasciitis may appear as heel pain (“heel spur syndrome”) when the source of pain and inflammation is located near the back of the foot—specifically, the heel. In other cases, it may affect the entire sole of the foot.
There are several possible causes of plantar fasciitis:
These are all potential risk factors. Often, it is the combination of several of these factors that leads to inflammation and resulting pain.
Stretching, when performed correctly, is a key tool in combating the symptoms of this condition. If the pain is mild and the inflammation is due to a temporary issue, plantar fasciitis can resolve within a few days through proper rest and stretching exercises.
However, in chronic cases, the condition becomes more difficult to treat, and medical therapies or even surgery may be required.
The diagnosis of plantar fasciitis is primarily clinical.
No specific test is strictly necessary to diagnose the condition.
However, it is crucial to evaluate the entire foot, not just the plantar fascia.
This means that examining the patient with a weight-bearing X-ray of both feet is essential. It helps us understand the underlying causes of the condition, gain insight into the foot's biomechanics, and determine the most appropriate therapeutic solutions.
The term heel spur refers to a bony "beak-like" formation on the heel bone (calcaneus), precisely where the plantar fascia attaches.
It is an osseous outgrowth located in the heel area and may appear in one out of four people during their lifetime.
The exact reason for its development is not always clear, and it is often an incidental finding on X-rays.
In popular belief, the heel spur is considered the main cause of pain and something that should be removed, dissolved, or scraped away. However, in reality, the spur is more often a consequence rather than the cause of pain.
Reduced blood flow and tightness of the plantar fascia can lead to the formation of this small bone spur at the point where the fascia inserts into the calcaneus.
This process can occur in both symptomatic patients (those experiencing pain under the foot or heel) and asymptomatic individuals.
Haglund's disease—more formally known as Sever-Blanke-Haglund syndrome—is a bony growth that develops during childhood on the posterior part of the heel bone (calcaneus), exactly where the Achilles tendon attaches.
It’s important to mention this condition in the context of plantar fasciitis because it can mimic similar symptoms or, in some cases, even occur alongside it.
Haglund’s disease typically appears during the growth phase in children, and in many cases, it resolves on its own, without the need for specific therapies or surgical intervention. It may also remain completely asymptomatic.
However, the problem can reappear in adulthood, often due to friction between the old bony prominence formed in youth and the Achilles tendon or surrounding soft tissues.
These are known as mechanical causes, such as:
Let’s now look at the main medical and surgical approaches used to treat plantar fasciitis and the related conditions that often cause it.
In most cases of painful symptoms affecting the plantar fascia, the issue can be resolved simply by performing specific stretching exercises, without the need for formal medical therapy.
Stretching should be performed twice a day (for example, in the morning and evening), following a strict routine—just as one would follow a medication regimen.
Use a step or an inclined surface to place the tip of your foot and gradually push your body weight in the same direction.
With the sole of your foot flat on the ground, slowly shift your body weight forward until you feel a gentle pressure at the top of your calf, just below the hollow of your knee.
With your legs spread apart, reach for the sole of your foot with your hands and progressively pull your toes toward you, being careful not to apply excessive force.
It’s important to remember that the resolution of plantar fasciitis won’t be immediate, and it may take weeks or months for the pain to decrease significantly.
You might be interested in: Achilles tendon stretching: Is there a correlation with plantar fasciitis?
Tecar therapy (Capacitive and Resistive Energy Transfer) is a physical therapy mainly used to treat trauma and inflammation, particularly effective in alleviating pain and inflammation in joints and muscles.
It involves using a capacitor applied to the affected area, which transfers biocompatible energy to the damaged tissues, inducing displacement currents.
Tecar Therapy is therefore able to accelerate the body’s natural repair processes.
Biological therapy is increasingly emerging, helping us in the treatment of many conditions. In this case, it involves tissue regeneration.
Undoubtedly, one of the most well-known therapies in this field is the use of PRP (Platelet-Rich Plasma), but nowadays, more and more techniques based on tissue regeneration are emerging, thanks to the results that Regenerative Medicine allows us to achieve.
Among the most advanced techniques, we can certainly mention the use of mesenchymal cells from the stromal fraction of fat.
PRP is a gel rich in platelets obtained through a small blood draw from the patient and aims to regenerate tissues, thanks to the high concentration of growth factors it contains. It is also used in aesthetic medicine and has significant anti-inflammatory properties. The application of PRP for plantar fasciitis, in most cases, significantly reduces painful symptoms.
When referring to mesenchymal cells from fat, it means extracting cells from adipose tissue. These are obtained through a small liposuction procedure and processed to select and isolate mesenchymal cells: multipotent cells, which are capable of having a regenerative effect in the tissues where they are injected.
Both of these techniques can be administered in a short time (a few hours), without the need for overnight stays in hospital settings.
However, the benefits are not immediate; they are progressively noticeable within a few weeks.
As mentioned, so-called "conservative" approaches do not always succeed in resolving plantar fasciitis, especially in chronic cases.
When regenerative medicine and Tecar Therapy fail, the best option is minimally invasive surgery, which, compared to traditional techniques, offers the advantage of being performed on an outpatient basis, significantly reducing recovery times and having a less aesthetic impact on the patient (the scars are almost invisible).
The procedure lasts 10-15 minutes and is performed under local anesthesia. It involves a small incision (more like a tiny hole) for the lengthening and cutting of the plantar fascia to promote bleeding and improve blood supply to the surrounding hypovascular tissue.
Thanks to the short duration of the surgery and the small incision, the postoperative recovery is minimally demanding for the patient: pain can be easily controlled in the immediate postoperative period, and it is possible to resume driving 12-15 days after the procedure.
The best way to prevent plantar fasciitis is by performing the right physical exercises.
The most challenging task is to balance muscle strengthening with stretching.
Too often, we prioritize muscle strengthening without considering stretching. It is excessive contraction of the calf muscle (gastrocnemius) that triggers plantar fasciitis in most cases.
Therefore, we need to focus on this muscle for prevention.
Plantar fasciitis is also a professional condition. Using high-quality, not excessively rigid or heavy anti-injury shoes is essential to prevent this pathology.
Pay attention to the shoes you wear daily, not just in your work environment. It is advisable to avoid flat shoes with unsupportive soles.
It’s also important to note that prevention involves evaluating other factors, including proper nutrition, maintaining a healthy lipid balance, and ensuring adequate vitamin D intake.
These are two key markers of well-being that we must learn to keep balanced, not only for the health of our plantar fascia!
In this section, we briefly answer the questions, summarizing the concepts expressed in the article.
When experiencing acute pain, rest and stretching are important. Stretching the posterior leg muscles, particularly the calf, is crucial and can provide quick relief if the inflammation is in its acute phase. It is also essential to avoid wearing flat shoes!
The primary symptom is pain, usually more intense in the morning or after a period of rest. It is a burning pain exacerbated by weight-bearing and walking. Muscular fatigue and cramps in the calf may also accompany the pain.
Stretching is definitely the first therapeutic step to take. It should be done consistently and continuously. Physical therapies are helpful, especially in cases of chronic plantar fasciitis. If the first two treatment options fail, regenerative medicine may be a viable alternative before considering surgical solutions.
The causes of plantar fasciitis can vary.