What is Plantar Fasciitis?
Plantar fasciitis is one of the most common causes of heel pain encountered by Canadian Certified Pedorthists, affecting one out of every ten people at some point in their lives.
The plantar fascia is a fibrous band that runs along the bottom of the foot. It starts at the heel bone and runs through the arch to the toes. Fascia, unlike muscle, has very little elasticity, making it easily irritated, inflamed, overused, or torn.
Plantar fasciitis is an inflammation of the fascia at your heel. There is a lot of academic debate about the true nature of plantar fasciitis. Some believe it is true inflammation, while others believe the tissues are deteriorating.
What is a Stress Fracture? (Calcaneal stress fracture)
Stress fractures are tiny cracks that form in a bone as a result of repeated stress, and they are most common in the bones of the foot and lower leg. Stress fractures are an overuse injury that affects athletes of all levels, particularly those who increase the frequency or intensity of their physical activity or training regimens abruptly. A stress fracture of the calcaneus is a small break in the heel bone. Stress fractures of the calcaneus (heel) are particularly common among long-distance runners and endurance athletes. Located at the back of the foot, the calcaneus is essential for walking and provides support and stability to the foot. While uncommon, calcaneus fractures can be severe and require medical treatment.
How to Diagnose Your Foot and Heel Pain
It can be hard to determine what condition is causing your foot pain without seeing a professional. Symptoms alone can give a general idea on your diagnosis, but further testing is often required. To get an accurate diagnosis of your foot pain, talk to your general practitioner.
Plantar fasciitis can be diagnosed through a patient history, symptoms and clinical tests, but imaging may be recommended if confirming abnormalities or degradation.
Imaging the bone will typically confirm a stress fracture diagnosis. A stress fracture can take 2-4 weeks to show on an x-ray, which can make the diagnosis more difficult than plantar fasciitis. A bone scan or MRI may be recommended when necessary to confirm a diagnosis.
When comparing between plantar fasciitis and a stress fracture, the symptoms can provide a clear picture if it’s one or the other, but not in all cases.
Causes for Plantar Fasciitis and Calcaneal stress fractures
Plantar fasciitis can be caused from factors such as a high arch, low arch or tight calf muscle. Plantar fasciitis can develop due to a change in routine or exercise or accumulate over time.
A calcaneal stress fracture is typically caused by repetitive stress to the heel bone (calcaneus). This type of stress fracture is seen more often in long distance runners because of the type of repetitive impact on the calcaneus. Other factors that may not have caused the stress fracture can contribute to increased stress, such as low or high arches, poor footwear, or a leg length difference.
Symptoms for Plantar Fasciitis and stress fractures
Plantar fasciitis pain presents on the inside bottom part of the heel or under the arch of the foot. Pain is typically worse when first stepping down in the morning or after periods of rest. The type of pain can vary from sharp, dull, aching, or burning. The intensity of pain varies depending on how it is described, but the location is usually consistent.
Pain from a calcaneal stress fracture presents on the very bottom of the heel. There may also be sensitivity to touch, swelling, pain from everyday activities that goes away with rest, unexplained pain at night or while sleeping. Symptoms can vary in intensity, and there may be times when symptoms are more severe than others.
Plantar fasciitis can be treated with stretching, replacing old, worn-out running shoes with new ones that provide adequate support, as well as custom foot orthotics or over the counter inserts.
Treatment for stress fractures is determined by the severity and location of the fracture. Most stress fractures heal completely in six to eight weeks. Your primary care provider is the best initial resource for this injury and can recommend lifestyle or activity changes, medications, or order any necessary imaging or diagnostic tests. To keep weight off the affected foot/leg, your doctor may advise you to use crutches or a removable cast walker.
A Canadian Certified Pedorthist can assist in controlling excessive foot movements that affect knee alignment and movement. To correct these movements and realign the lower limb, your Pedorthist may recommend a specific shoe or incorporate an orthotic device. More severe stress fractures may necessitate physical therapy or surgery to fully heal. The surgeon will use pins, screws, or plates to hold the bones in place while the fracture heals in these cases.
When an injury occurs, consult a Canadian Certified Pedorthist to see if an over-the-counter device or a custom-made foot orthotic, combined with appropriate footwear, will aid in the healing process and prevent problems from recurring.
Written by Reza Sands