Oral steroids work for plantar fasciitis

Plantar fasciitis: what helps?

Regular elevation relieves the foot with plantar fasciitis.
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Plantar fasciitis (also called plantar tendonitis, plantar fasciosis, plantar fasciopathy or plantar fasciitis) is a painful, usually one-sided and chronic inflammation of the plantar fascia.

The plantar fascia is a tendon plate of the sole of the foot consisting of firm fascia tissue (connective tissue), which connects toes, metatarsal bones and heel bone and supports the longitudinal arch of the foot. In addition, the plantar fascia provides stability when walking, because numerous nerves that provide orientation end in it. It is estimated that around 80 percent of all heel pain is due to plantar fasciitis.

The disease is considered to be widespread, but there are no reliable figures on its frequency. Experts estimate that around one in ten people will experience inflammation-related pain in the heel at least once in their lifetime. People between the ages of 45 and 65 are particularly affected. In principle, plantar fasciitis can occur at any age. Women are more vulnerable than men.

At a glance:

Heel spur: how to get rid of it

Causes and Risk Factors of Plantar Fasciitis

A combination of different factors often leads to inflammation of the plantar fascia, which is why experts speak of a multifactorial development. The trigger is usually an overload or irritation of the plantar tendon.

The main risk factors are:

  • Overweight / obesity (body mass index / BMI> 27)
  • a shortened calf muscles (Achilles tendon), which is anatomically associated with increased tension of the plantar tendon
  • various malpositions of the feet (for example arches, flat feet or flat feet)
  • different leg lengths (pelvic inclination)
  • Muscular imbalances (for example in the hip, lumbar spine, knee or trunk muscles)
  • minor accidents (e.g. bruises in the heel area)
  • Bursitis in the area of ​​the plantar fascia attachment
  • a standing professional activity
  • a lot of traffic
  • shoes that are too tight or frequent wearing of high heels
  • insufficiently developed foot muscles

Heel spur (calcaneus spur) can also be the cause of plantar fasciitis. It is a thorn-like bone outgrowth (calcium deposits) in the area of ​​the sole of the foot (plantar) or at the attachment of the Achilles tendon (dorsal / cranial), which usually arises from years of overloading of the respective area and can trigger cracks and inflammations in the surrounding tissue . However, recent studies have come to the conclusion that heel spur is more often the result of plantar tendinitis than its cause.

Plantar fasciitis is often caused by intense exercise. All running disciplines (sprint, medium-distance and long-distance running), basketball, football, dancing and tennis are considered risk sports.

Which symptoms are characteristic of plantar fasciitis?

Typical of an inflammation of the plantar fascia are severe (often described as stinging) heel pain in the foot, which primarily occurs during the first steps directly after standing up or generally when the tendon is first loaded after a long period of inactivity (starting pain). In the advanced stage of the inflammation, the pain often radiates into the entire sole of the foot and to the Achilles tendon or can be clearly felt when lying down. Many sufferers find it difficult to pull on the inflamed foot.

Classically, athletes primarily register heel pain when they warm up. In the course of the further training, the symptoms then become weaker or subside completely. Intense sprints and jumps or a consistently heavy load on the foot can reactivate the symptoms. If the heel continues to be heavily loaded, the pain usually also increases.

The most important differential diagnoses (other diseases with similar symptoms) for plantar fasciitis are:

  • Arthrosis in the ankle
  • Reiter's disease (Reiter's syndrome)
  • Bechterew's disease (ankylosing spondylitis)
  • rheumatoid arthritis (rheumatoid arthritis)
  • Broken bones (fractures)
  • Soft tissue abscesses (especially if you have a pre-existing condition such as diabetes mellitus)
  • Tumors in the foot area

How is plantar fasciitis diagnosed?

If the pain in the heel area is unclear or if there is a specific suspicion of plantar tendinitis, the orthopedic surgeon is the right contact. On the basis of a thorough anamnesis and a clinical examination, he can usually make the diagnosis of plantar fasciitis quickly and often even without the aid of imaging procedures.

When taking the anamnesis, for example, the doctor asks about the type, occurrence and location of the pain as well as the course of the disease, previous illnesses and regular athletic / professional stress on the heel.

The clinical examination for heel pain initially includes a tactile examination (palpation): If the symptoms are aggravated by feeling or pressing the plantar fascia attachment on the heel, this indicates plantar fasciitis.

The so-called Silfverskjöld test, named after the person who first described it, the Swedish orthopedic surgeon and surgeon Nils Silfversköld, is suitable for detecting certain foot deformities or shortened calf muscles Checked right angle bent knee.

An x-ray of the foot is usually only taken if the heel pain persists despite long-term conservative therapy. For example, heel spurs or connective tissue calcifications and thickenings are clearly visible on it. The use of other imaging methods such as ultrasound (sonography), magnetic resonance tomography (MRT) or skeletal scintigraphy is also possible in the context of diagnostics, but their necessity is controversial among specialists.

What helps against plantar fasciitis?

It is reported in many medical publications that heel pain regresses or disappears within a year, regardless of therapy. However, this thesis has not yet been supported by scientific studies. What is certain is that more than 90 percent of all those affected by conservative treatment approaches work well within six months. These include:

Drug therapies:

In acute, painful plantar fasciitis, non-steroidal anti-inflammatory drugs (NSAIDs) are usually given (oral): pain relievers with drugs such as acetylsalicylic acid, arylpropionic acid derivatives (e.g. ibuprofen) or arylacetic acid derivatives (e.g. diclofenac), which have anti-inflammatory effects at the same time. Topically applied ointments or gels with ibuprofen or diclofenac can also help against heel pain, but are less effective than tablets due to their shallow penetration depth. Corresponding gels have a decongestant and anti-inflammatory cooling effect at the same time.

Injecting a local anesthetic into the painful heel area can also lead to temporary relief. Many people affected also have positive experiences with cortisone injections (glucocorticoid injections). However, since the anti-inflammatory steroid hormone can have side effects such as atrophy of the plantar fat pad or tendon tears (ruptures), experts believe that a maximum of two to three glucocorticoid injections should be administered.

So far, little research has been done on newer drug treatment methods such as the injection of botulinum toxin (Botox) or platelet-rich plasma (PRP) - the patient's own blood plasma that is enriched with blood platelets and is therefore said to contain highly concentrated growth factors for wound healing.

Relieving therapies:

All measures that reduce chronic overloading of the plantar fascia fall into this category, for example:

  • Weight loss in people with pre-obesity or obesity

  • regular elevation of the affected foot

  • Provision of individually adapted, corrective shoe insoles with which the longitudinal arch of the foot is supported in the case of existing deformities (pressure reduction)

  • The (long-term) wearing of a so-called night splint (orthosis), with the help of which the tip of the foot is stretched towards the shin, can stretch the tendon plate and accelerate the healing process

  • Reduction of sporting activities that are likely to overload the plantar fascia

  • Training only in pain-free intervals

  • the choice of suitable, well-padded shoes for every sport / activity

  • changing positions with standing professional activity

Stimulating therapies:

Regular stretching and isometric training for calf muscles and plantar fascia are recommended. According to studies, good results (up to and including complete freedom from pain) can be achieved with it both in the short and long term. It makes sense to have professional guidance from a specialized physiotherapist. The same goes for exercises to strengthen the muscles of the feet. Regular cooling of the painful tissue can also effectively reduce the inflammation.

A low-dose X-ray radiation (low-dose radiotherapy) should, among other things, promote the blood flow to the inflamed tissue and thus help against inflammation and pain. However, long-term effects of radiation over a period of more than eight years have not yet been investigated.

The method of extracorporeal shock wave therapy (ESWT), in which precisely aligned pressure waves generated electromagnetically with the help of a sound probe destroy painful deposits such as a heel spur, can represent a further therapeutic option.

(Dry) Needling is a method from physiotherapy in which fine needles are placed in the soles of the feet and then gently moved to trigger a reaction in the muscle. This treatment option is perceived as painful by some patients.

In-house treatments such as foot and heel massages that promote blood circulation, acupressure or taping (instructions are available online) can also do you good and alleviate pain.

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Home remedies for plantar fasciitis

Various home remedies are recommended for inflammation in the heel, but their effects have not been scientifically proven, for example:

  • Foot baths or poultices with apple cider vinegar: put half a cup of apple cider vinegar in a small tub of warm water, soak your feet in it for five to ten minutes; Soak the cotton cloth in a mixture of vinegar and water, wring it out and wrap it around the painful foot.

  • Baking powder wrap: mix half a teaspoon of baking powder with water to a thick paste, place on the painful area, place a cotton cloth over it.

  • Quark compresses: put cold low-fat quark thickly on the painful areas, cover with a kitchen towel and wrap a cotton towel around it, leave on for at least 20 minutes, rinse with cool water.

  • Rub in with marmot fat (pharmacy): Massage the ointment onto the painful area several times a day.

  • Homeopathy for plantar fasciitis: Homeopaths recommend the combined intake of Symphytum officinale 200C and Rhus toxicodendron 30C against inflammation of the plantar marriage.

When is an operation to relieve the plantar fascia necessary?

Overall, plantar fasciitis only requires surgery very seldom because multimodal conservative therapies usually work well. If the heel pain persists for more than twelve months despite conservative treatment and diagnostic exclusion of other causes and significantly restricts the quality of life, those affected should weigh up with their orthopedic surgeon whether a surgical intervention could be useful. A second medical opinion can be helpful in this case.

Surgery is performed on about 1 in 100 people with plantar fasciitis. However, the operation is no guarantee of permanent freedom from symptoms: according to studies, around 70 to 90 percent of all operated patients are satisfied with the result.

There are different surgical techniques for reducing heel pain. One possible procedure is fasciotomy, which involves partially cutting the inflamed tendon. The aim is to relieve the pressurized part of the plantar fascia directly on the heel bone, because the tissue here is often abnormally thickened, calcified, scarred, stiffened or torn in the case of stubborn inflammation.

A fasciotomy can now be performed arthroscopically through small incisions using an endoscope and a tiny cutting instrument (keyhole technology). The minimally invasive procedure is said to lead to a faster recovery compared to an open procedure: according to studies, endoscopically operated patients with plantar fasciitis can return to their workplaces much earlier.

Another possible surgical procedure is the relieving mobilization of the (possibly shortened) calf muscle (Musculus gastrocnemius) by notching this muscle fascia. If necessary, this procedure can be combined with a fasciotomy.

A calcaneal spur usually does not have to be removed surgically. However, if it is so pronounced and located that it actually causes painful damage to the surrounding tissue, it can be removed endoscopically.

Due to the high risk of injury, all such procedures should only be performed by highly specialized foot and ankle surgeons.

What is the typical course of plantar fasciitis?

Specialists speak of a "creeping character" of the inflammation: the pain in the heel occurs only sporadically at first and disappears again when the patient is resting. If the stress or irritation of the plantar tendon remains the same, however, the symptoms occur more frequently and with increasing intensity.

Since people with heel pain often switch to other positions when walking - for example, instead of stepping with the heel or walking on tiptoe (relieving limp) - chronic plantar fasciitis can overload other areas of the body such as the spine, knees, hips or ankles in the long term / or be damaged. The relieving posture leads to strong and painful muscular tension in the long term. If left untreated, plantar tendinitis can endanger mobility.

The prognosis for plantar fasciitis is generally very good, as measures such as relief, cooling, compresses and other home remedies, as well as conservative medical therapies, effectively relieve the inflammation until it finally disappears completely.

If an operation is necessary, follow-up care can take a long time, depending on the surgical procedure: The tissue must be protected and spared for four to six weeks, i.e. the foot should be immobilized as much as possible and not put under any strain. As a rule, the attending physician then prescribes a gradual reloading and movement, which is accompanied by physiotherapy. It takes an average of six to twelve months for the foot to fully recover after the procedure.

How long the patient is on sick leave after a corresponding operation depends on the healing process and occupation. The same applies to a sick leave for conservatively treated plantar fasciitis. Sitting activities can usually be resumed much faster than standing or physically demanding jobs.

How can plantar fasciitis be prevented?

Since an inflammation of the plantar tendon is usually caused by overloading, the risk of the disease can be significantly reduced by the following preventive measures:

  • The BMI should be in the normal range. Weight reduction is recommended if you are pre-obese or obese.

  • The entire foot should be well supplied with blood. Therefore, in addition to regular exercise and muscular training, foot massages (for example with the help of a hedgehog ball or a fascia roll) and cold water stimuli (Kneipp applications) are useful.

  • Cigarettes should definitely be avoided because smoking constricts the blood vessels and inhibits the oxygen supply to the tissue.

  • To relieve the feet, they should be raised when the muscles are exhausted.

  • Calluses on the heel and soles of the feet can be prevented by nourishing foot baths, softening creams and, if necessary, podiatry removal of the callus. Regular medical foot care is recommended for problem feet.

  • Shoes for work and leisure should be flat and comfortable (well padded) and should be changed more often.

  • Frequent changing of the standing position is recommended for standing work.

  • Recreational athletes who are prone to tendon problems should avoid high-risk sports such as running, tennis, dancing, basketball and football and switch to alternatives such as cycling and swimming, as there is little or no pressure on the heel and sole of the foot.

  • In principle, individually adapted special footwear should be worn during sport (many specialist shops offer foot and running analyzes).

  • Particularly in running disciplines, you should pay attention to a slow increase in training, otherwise overload situations will quickly arise.

  • Regular stretching and strengthening exercises for muscles and tendons keep the feet robust and healthy and effectively prevent plantar fasciitis.

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