- André Biernath – @andre_biernath
- From BBC News Brazil in London
The person wakes up after a good night’s sleep, gets out of bed and, as he puts his feet on the floor, he feels a shock or a twinge in his heel, which comes from the bottom up. She then needs to walk on her fingertips while changing, going to the bathroom or preparing breakfast.
This scene, which happens at some point in life with up to 10% of the population, is a typical description of a disease known as plantar fasciitis.
It usually appears after the third or fourth decade of life and is caused by a number of factors, ranging from the use of inappropriate shoes to being overweight.
“It is a pain that greatly affects the person’s quality of life and, if left untreated, can lead to other dysfunctions in the knees, hips and even the spine”, warns orthopedist foot specialist Fernanda Catena, from the Hospital 9th of July, in São Paulo.
The good news is that the treatment of this problem has evolved a lot in recent years — nowadays, there are options for physical therapy and interventions at the site of pain that allow resorting to surgery only as a last resort.
But, before knowing the details of all these therapeutic options, it is necessary to understand what is plantar fasciitis.
A ‘bridge’ connecting toes and heels
The plantar fascia is a ligament that we have in our feet. It is responsible for connecting the heel with the bones of the toes.
“This structure is important for the quality of the gait and the propulsion of the steps. When we take our feet off the ground, this movement largely depends on the work of the plantar fascia”, teaches Catena.
The problem is that this ligament can become inflamed for a number of reasons, which we will talk about later.
“And the inflammation, which is usually concentrated at the base of the heel and generates pain, is what we call plantar fasciitis”, says orthopedist specialist in feet and ankles Marco Túlio Costa, who works at the Cohen Institute and the Hospital Israelita Albert Einstein. , both in São Paulo.
In the past, it was believed that fasciitis was related to the appearance of a spur, a bone formation that supposedly tightened the ligament.
“Today, we know that pain is related to inflammation itself”, differentiates the doctor, who is also head of the Foot and Ankle Group at the Santa Casa de Misericórdia de São Paulo.
But, after all, what ignites this structure so important to our movements?
Costa explains that one of the most common causes of fasciitis is the lack of stretching of the muscles that make up the thighs and legs.
“If those muscles aren’t stretched enough, there’s an overload on the feet, especially the fasciae.”
“Another frequent cause of fasciitis are repetitive impacts that cause microtraumas, such as those that appear in street runners”, exemplifies the specialist.
The formation of the body itself may also be behind the problem: flat feet (without that natural curvature) or very arched feet are also promoters of inflammation in the fascia.
In this context, you cannot ignore the impact of being overweight or obese — the extra pounds put an excessive load on bones, joints, tendons and ligaments — and the inappropriate use of footwear, which takes away the natural balance of the feet.
Finally, Catena recalls the biological factors that instigate the picture. “Older individuals, those with uncontrolled diabetes or who smoke may suffer more from inflammation that affects different parts of the body, such as fascia,” she adds.
Not all foot pain is fasciitis
Now that you have understood the basics of this problem, it is important to make an alert: only the doctor can make the proper diagnosis and propose the best treatment.
“Many times, we receive patients in the office who say they have plantar fasciitis. Hence, when we examine, we discover that the pain is not in the heel region, but in the instep or in the toes”, says Catena.
These other discomforts can be caused by various conditions, such as microfractures, inflammation in the Achilles heel, tendinitis, bunions, corns…
And, for each of them, there is a specific treatment — after all, there’s no point in taking non-stop anti-inflammatories when your problem is a cracked bone or deformed fingers from wearing high heels with pointy toes.
To close the diagnosis of plantar fasciitis, in addition to the physical analysis performed during the consultation, the orthopedist may request some imaging tests, such as ultrasound or MRI.
Problem detected, it’s time to know the options to solve (or alleviate) the situation.
Expanded therapeutic arsenal
Gone are the days when surgery was the only option available to deal with heel pricks.
The first line of care involves physical therapy sessions and stretching or muscle strengthening exercises, with a special focus on the legs and feet.
“To relieve pain and inflammation, we suggest placing a 600 ml bottle of water in the refrigerator until frozen. Afterwards, the patient is rolling the object on the floor with the soles of his feet”, says the orthopedist.
“The use of good quality shoes, such as sneakers that have a good cushioning capacity, also helps”, he adds.
Treating possible factors that promote inflammation — such as smoking, being overweight and diabetes — is another action that allows you to nip it in the bud.
Still within the basic recommendations, the practice of physical activities is essential, especially for those who need to lose weight. The secret here is to look for a modality that doesn’t force your feet so much, but allows you to burn calories. In this scenario, swimming and cycling are usually good options.
If the first attempts fail, the doctor usually moves on to a second strategy.
“We can use shock wave therapy, performed using a device, or perform infiltrations and injections in the affected site”, exemplifies Catena.
The goal is to promote ligament regeneration and get rid of all that inflammation.
This set of alternatives works more than 90% of the time. However, if the foot continues to hurt after six months of unsuccessful attempts, surgery will be required.
“I usually say that if the patient doesn’t stretch the muscles and fascia properly, I’ll have to do it with the scalpel”, jokes Costa.
But even surgical interventions have become simpler in recent times. “Currently, the cuts are smaller and can be made endoscopically, through less invasive holes”, says the doctor.
Some specialists also recommend that the operation be performed on the leg muscles, and not on the plantar fascia, since, in many cases, the lack of stretching of these structures generates inflammation in the ligament of the sole of the foot.
And, of course, all these features — from the simplest to the far-fetched — work best if the diagnosis of fasciitis is made early on.
This ensures less pain, less risk of complications in other parts of the body and free and light feet to walk or run without major worries.
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