Plantar fasciitis is a thick fibrous aponeurosis degenerative change with repetitive overuses injury in the sole inferior side or planer side heel pain that is caused by repetitive traction force on the connective tissue and fascia that are originated from the distal calcaneus in a patient of prolonged standing, walking, running, athlete, cricket player, jumping in an uneven surface, arch problem and obesity people. The fascia is a thick broadband connective tissue that includes a thick central, medial and lateral component that provides never-ending effects on the sole of the foot and maintains the longitudinal arch proximally to the medial tubercle of the calcaneus. The fiber of the plantar fascia bend with the dermis transverse ligament with flexor sheath.
Causes of Plantar Fasciitis
The causes of right or left leg planter fascitis are
Previous plantar fasciitis problem
- Road traffic accident with ankle and sole injury.
- Jumping from the high
- Abnormal or incorrect footwears
Plantar heel fat pad atrophy with muscle spasms
Calcaneal stress fractures
Blunt trauma to the calcareous
- Attack something or forceful pressure by the food
Neurogenic causes, such as entrapment of the tibial nerve (posterior tarsal tunnel syndrome), medial calcaneal nerve, and Baxter’s nerve
Tumors, osteomyelitis, and plantar warts
S1 radiculopathy with radiating pain
- Abnormal arch
- Marton toe, bow leg, pea cavas
- Tendon and ligament injury in right or left leg
Rheumatoid arthritis (RA)
Seronegative spondyloarthropathies (SpA)
Sickle cell bony pain
Achilles tendon injuries
Distal plantar fasciitis
Tarsal tunnel syndrome
Symptoms of Plantar Fasciitis
The symptoms of right and left leg planter fascitis are described bellow
- Pain, swelling, tenderness in the sole of the foot is the first symptoms
- Pain may increase during stretching, walking, running in the right or left leg planter facilities
- The pain may be an increase or worsen in the morning with discomfort on the first or initial steps after getting from the bed.
- Pain with warms increases with the movement and the condition of pain may progress during walking or daily activities in case of right leg or left leg plantar fasciitis.
- Pain in inversion or eversion in the right leg or left leg
- The burning sensation may be feeling when the feet are placed on the uneven surface
- Tingling sensation intolerable pain may feel when the feet are pressure in small stone, break a piece or even floor
- The pain may decrease with ambulation or beginning of athletic activities, cricket playing, but then increase all the day when activities are increasing in case of right leg or left leg plantar fasciitis.
- The normal range of motion may be decreased and may feel discomfort in wearing your footwears
Diagnosis of Plantar Fasciitis
- On examination – In the physical appearance your doctor can not see any abnormality such as swelling, skin rash, wort, skin change cyanosis, paling is not found in a physical examination in both right and left leg plantar fascitis
- Palpitation – In this examination patient may feel pain, tenderness when pressure creates in the heel. It may worsen in the morning. Pain may feel in stretching of leg, sole, and foot. In some cases, the arch of the foot may be flat, or abnormal bony deformity may be felt during palpation
- Windlass (or Jack’s) test – In this test are done by the passive dorsiflexion of the first metatarsophalangeal joint and if pain can usually reproduce and feel by palpating calcaneal tubercle on the plantar fascia insertion then it called the positive test
- Positive squeeze test – The test is done by compression of the calcaneus and if pain tenderness is felt patient then it called the positive
- Tinel’s sign – The test is considered positive when the tapping on the behind area of the medial malleolus If patients feel pain, tingling, hypoesthesia, and paresthesia along the whole plantar surface.
- Laboratory tests- Leukocytosis is one of the most important tests for right leg or left leg plantar fasciitis that supports the possibility of infection and bone-related disease. Blood cultures, urine examination, or other possible primary sites of foot bone infection that obligatory when a septic infectious joint is being considered for examination. The and elevated inflammatory condition markers like ESR or CRP include suggesting an infectious or inflammatory disease condition of the ankle joints.
- A serum uric acid level – It is often considered by clinicians and doctors when gout, pseudogout is suspected, but it is not a reliable and dangerous condition as it may be spuriously elevated or high in acute inflammatory conditions or acutely during a right leg or left leg plantar fasciitis or not
- Ultrasound – It is basically done to investigate the thickness of the fascia, ligament injury with chronic heel pain are likely to have a thickened plantar fascia with the associated fluid collection, and that thickness values >4.0 mm that are the diagnostic of plantar fasciitis in right and left leg plantar fascitis.[rx]
- Radiographs of the joint – Conventional x-ray and radiography is the most widely used imaging modality and allows for the detection of bone fractures, osteoporosis, and abnormal pathologies condition like fracture, osteoporosis, erosions, osteonecrosis, osteoarthritis, or a juxta-articular bone tumor, neoplasm. Characteristic features of hand rheumatoid arthritis include marginal osteophytes formation, joint space gradually narrowing, subchondral sclerosis formation, and right leg or left leg plantar fasciitis.
- CT Scan – High contrast CT scan is more effective to diagnose right leg or left leg plantar fasciitis. Abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc.
- MRI – It is called magnetic radical imaging is also helpful to find the bone conditions, abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc. It is the final stage test to confirm that all joint right leg or left leg plantar fasciitis or any other abnormality. suspected others condition heel pain, such as tarsal tunnel syndrome, soft tissue injury and bone tumors, osteonecrosis, osteomyelitis, subtalar arthritis, and stress fracture.[rx,rx]
- Bone scintigraphy – It is the most important test to diagnose bone cancer, neoplasm, fractures, necrosis of bone, and joints. It also helps to identify the tendon, sprained ligament, cartilage, muscle spasm.
Treatment of Plantar Fasciitis
- Protection – In ankle right leg or left leg plantar fasciitis, and acute or chronic injury with pain in the heel. Protection means the save the ankle joint and sole of the foot from further injury and dislocation, sprain, strain. It can be done by the tapping process or adhesive bandage.
- Rest – After an injury from the right leg or left leg plantar fasciitis of the ankle, the lag is kept in rest for some time today to prevent injury and accelerate the healing. It is an excellent manual process to protect ankle joints and the sole of the foot.
- Ice – The application after acute injury is helpful for the healing process of ankle joints. It basically constricted the peripheral blood vessel that helps to prevent edema, swelling, or accumulated water. It can be used alternatively by ice and heat therapy at the same time.
- Compression – It is the most important manual techniques to protect the swelling, effusion and keep the tendon, ligament, cartilage intake and regenerate the joint cartilage.
- Elevation – Elevation is the process to prevent swelling, edema, and fluid accumulation in ankle joints. Your doctor may advise elevating the legs at the same position as the heart vertically. The leg must be elevated just a small high comparing to the heart position in sleeping times.
- Physiotherapy – It is one of the most common and effective non-pharmacological treatments in the world. It has a variety of treatment module to erase acute and chronic pain. It is especially helpful in muscle spasticity, spasms related to hand and shoulder or backs pain. Inflammatory and noninflammatory pain is treated by ultrasound, MRI, Shortwave, microwave, wax therapy, IRR, laser therapy, interferential current therapy, iontophoresis.
- Exercise – Different types of exercise may be done under the supervision of a physiotherapist or healthcare provider. It falls into the active range of motion, tapping, isometric movement, active range of movement, or passive range of motion of right leg or left leg plantar fasciitis.
- Stretching – It is one of the most helpful treatments to reduce muscle pain, spasm, spasticity that is gradually increasing due to old age and not perform daily workouts or activities.
- Bracing – It is one of the most important self-help devices that is used in right leg or left leg plantar fasciitis and, maintaining proper joint position, reducing swelling, improve posture and maintain the range of motion exercise.
- Acupuncture – It is the China-oriented acute and chronic treatment system where are needle is used to stimulate the pain receptor to reduce pain. It is also helpful in some spasticity formation pain, stroke, hemiplegia, and chronic rheumatoid arthritis pain in the hand.
- Deep friction massage – It is very helpful in the treatment of right leg or left leg plantar fasciitis. It is done by the physiotherapy expert that is sudden forceful thrust to prevent the abnormal muscle, ligament, tendon, in right or left leg plantar fasciitis. It is very helpful for maintaining the arch of food.
- Extracorporeal shock-wave therapy – It is a multidisciplinary device that is used to relieve pain, enhance mobility, improve the tendon, cartilage, ligament injury, and pain. It is basically used by the physiotherapist, orthotist, sports medicine to erase acute and chronic pain.
- Roll plantar fascia with can, bottles, or ball – It is considered to keeping the bedside to perform a minimum of 10 minutes before going to bed to sleep and before taking the first step in the morning. It can be rolled for planter facilities for one minute in 3 times a minimum of 30 seconds in between. Your doctors may advise performing in your home for 15 days.
- The calf muscle and arch stretching – It is a very easy and self-treatment system to perform in your home keeping the towel near the bedside and perform before going to bed and taking the first step in the morning and continue to Pull back on foot for 30 seconds 3 times with 30 seconds of rest in between.
- Cross friction massage – It is done by manually stretching with cross friction massage. The stretch and massage before taking first steps from bed for 1 minute 3 times with 30 seconds of rest in between. you can repeat
- Diet – Diet may be normal or according to the doctor mentions food you can take for you, such as papaya, banana, potato, nut cereal, seasonal fruits, and drink of water. In your daily routine meal must have magnesium, calcium, iron, zinc, folate, vitamin B complex, Vitamin A, Vitamin C, etc.
- NSAIDs – It is considered to be the fast-acting nonsteroidal anti-inflammatory drugs (NSAIDs) as including acetylsalicylate, naproxen, ibuprofen, indomethacin, and etodolac, ketorolac in pain is acute. Aspirin is also an effective anti-inflammatory for ankle osteoarthritis rheumatoid arthritis when used at high doses, due to the decrease or inhibition of prostaglandin synthesis. It is also called one of the oldest NSAIDs used for multiple joint pain. NSAIDs work by inhibiting cyclo-oxygenase to prevent the synthesis of prostaglandins, prostacyclin, and thromboxanes. It has also some side effects of aspirin at high doses when used are including tinnitus, hearing loss, and gastric intolerance.
- Vitamin B1, B6, and B12 – It is essential for neuropathic pain management, pernicious anemia, with vitamin b complex deficiency pain, paresthesia, numbness, itching with diabetic neuropathy pain, myalgia, etc. A side effect may be nausea- vomiting, abdominal pain, cramping
- Corticosteroid injections – Corticosteroids to healing the nerve inflammation and clotted blood in the torn fascia that is accumulated in the joint pain. The injections may provide temporary pain relief anywhere from days to several months. With repeated injections, several times the patient may experience a more permanent improvement in their symptoms.[rx] The steroid injections are typically used in severe conditions when normal treatment can not respond.[rx] Common side effects muscle cramping, increase metabolism, dry mouth, vertigo, blurred vision.
- Dietary supplement – Especially seasonal fruit vitamin B complex, vitamin b12, omega-3 fatty acid, antioxidant, spirulina, cord liver oil, avocado soybean unsaponifiables, fish oil, etc to remove general weakness & improved health.
- Injections – For patients with severe pain, especially leg pain, steroid injections may be a reasonable treatment option to reduce chronic plantar fasciitis pain in the right or left leg. The injections are effective in helping to reduce pain and increase a patient’s functional mobility and increase the range of motion. If a steroid injection does work to relieve the patient’s pain, it can be done up to three times per year. Injections your doctor injects cortisone into the affected joint to give you temporary relief from the pain and inflammation.
- Botulinum toxin A – It is the terminal stage of treatment in right and left leg plantar fasciitis. The injection is pushed to the torn fascia to heal inflammation, pain, irritation quickly. Your doctor decides whether the injection are needed or not
- Platelet–rich plasma (PRP) – It is a kind of therapy that uses an injection form of a concentration of patients platelets to accelerate the healing of the tendon, cartilage, ligament, muscle, and joints injury. It is very helpful in the treatment of musculoskeletal disease conditions.
Basically, the surgical procedure does not need to heal the plantar fasciitis. But in severe cases, surgery means fasciotomy may be needed. It is done by either an open or endoscopy approach or laser treatment. However, the surgical release does not guarantee a successful result of right and left leg plantar fasciitis. But there have complications of surgery include nerve injury, plantar fascia rupture, and flattening of the longitudinal arch.