Do you feel heel pain in the morning or when jogging/running? It is very likely that you have plantar fasciitis . Heel complaints are usually chronic and have a high incidence, approximately 10% of the population, where they occur mostly in middle-aged women who are overweight, or in young athletes. Although most do not require surgical therapy, the treatment requires patient patience.
Know the anatomy of the heel
To be able to understand this disease, it is better if we first understand a little about the anatomy of the heel. The calcaneus bone, or heel bone, is separated from the skin by a honeycomb-shaped bundle of muscle and fat fibers that acts as a shock absorber. The plantar fascia is a group of muscles that is shaped like a fan and has five strands and attaches to the heel bone. In the skin in the heel area, there is innervation that will give pain when it is pressed or stimulated.
Why does plantar fasciitis occur?
Plantar fasciitis occurs due to degeneration of the plantar fascia resulting from repetitive motions and micro tears which cause an inflammatory reaction. The cause of plantar fasciitis is believed to be multifactorial, with abnormal biomechanics and delayed healing as contributing factors. Some of the risk factors that cause plantar fasciitis are flat feet , high arches , tight Achilles tendon or calf muscles, tense inner leg muscles, differences in leg length, obesity, running or walking activities. for a long time, wearing shoes that don't fit and walking posture that doesn't fit.
The main complaint of patients coming to the regular doctor is heel pain that occurs in the morning or standing up after sitting for a long time. On examination, there will be pain in the inner side of the heel, tension in the Achilles tendon or calf muscles. X-rays can be taken to rule out abnormalities in the bones, or fractures of the heel. As a support, an ultrasound examination can also be carried out to rule out other abnormalities and see the thickness of the plantar fascia and the presence of tears in the fascia layer.
Treatment of plantar fasciitis
Most of these complaints can be reduced within one year with conservative therapy. Therapy can be done by resting the feet and modifying activities to allow healing to occur. Cold compresses or ice can also be given to relieve inflammation symptoms. Sometimes, non-steroidal anti-inflammatory drugs are needed to help relieve inflammation. Sufferers also need discipline in stretching the plantar fascia and achilles tendon. Another thing that can be done is the use of insoles, both in the form of silicone and plastic so that they can improve the biomechanics of the feet and reduce pressure. Splints that are used at night can also help to prevent the leg from being too stiff during sleep and can increase the elasticity of the muscles.
In cases that require more invasive procedures, injections can be performed, but care must be taken with complications such as pain at the injection site, atrophy of fat, infection, nerve injury, and plantar fascia tear. In cases where conservative measures are unsuccessful, extracorporeal shock wave therapy (ESWT) can be added using high-energy sound waves. The last option is to do surgery if the complaint does not improve for 6-12 months, which can be done with minimally invasive techniques.
To prevent plantar fasciitis , you can choose footwear with comfortable cushioning at the heel, avoid standing for a long time, stretch especially the plantar fascia and achilles tendon, and maintain an ideal body weight.
Article written by dr. Steesy Benedicta, M. Ked. Klin, Sp.OT (Orthopedic & Traumatology Specialist Doctor at EMC Pulomas Hospital).