Plantar fasciitis is a painful syndrome affecting the muscle-ligament structure present in the sole of the foot. It has long been considered a simply connective disease, due to problems and alterations of the load.
Nervenia, supported by state-of-the-art scientific studies published in recent years, instead deals with it as a neuropathy, ie as an alteration of nerve function, obviously associated with classical mechanical causes. Plantar fasciitis is more common in the female sphere and in subjects who have problems with obesity; in these last subjects the weight of the body causes the crushing of the soft parts of the foot causing stress.
Postural or mechanical causes have always been hypothesized for plantar fasciitis. Instead, an interesting study was published in 2017 that reveals how this pathology is mainly due to irritation of the plantar nerve, the last section of the sciatic nerve.
This hypothesis supports the concept now universally known but often forgotten in its practical applications, so that a nerve, in addition to the sensory and motor function, also has an important trophic function. In short, the well-being and health of a tissue depend largely, if not totally, on the signals that the nerve sends to these tissues.
So if a nerve has any kind of suffering along its path, it leads to alterations of nourishment and formation also to the tissues to which this nerve is directed. In plantar fasciitis the heel spur is one of these alterations, where initial load irritation affects the plantar nerve which, disturbed in its data transmission process, causes fibrosis and thickening first, then calcification of the posterior part of the plantar fascia, with the formation of the so-called calcaneal spine.
Initially, plantar fasciitis creates pain in the sole of the foot, in the heel area, especially in the first few steps in the morning. With the passage of time the pain becomes persistent throughout the day, until walking becomes very problematic. Plantar fasciitis is accompanied by the formation of the “heel spur or spine”. Pain may increase with physical activity.
The diagnosis of plantar fasciitis is essentially clinical, ie based on the patient’s clinical history. In many cases, to choose the most appropriate therapy, it is useful to carry out an ultrasound scan of the soft tissues of the fascia or a radiograph of the foot. An in-depth radiological examination is appropriate for some specific situations such as calcaneal bursitis, posteromedial tarsal tunnel syndrome, rupture of the plantar fascia with episodes of swelling and chronic situations such as heel stress.
Cures and remedies
For a resolution of plantar fasciitis, it takes from 6 to 12 months. Classic treatments include general and local anti-inflammatories, physiotherapy and ice applications, shock waves and local infiltrations, together with total or reduced orthotics to allow correct and soft support.
These approaches are not equivalent, but must be carefully chosen on the clinical picture present at the time of evaluation of the patient suffering from acute or chronic plantar fasciitis.
In the most serious cases, surgery must be performed with the removal of the spine, and detensionation with resection of the plantar fascia, which can currently be performed endoscopically.
In the Nervenia studies, classic treatments are integrated with the analysis of the functional integrity of the plantar/sciatic nerve and, when necessary, the treatment with Deep Nerve Stimulation (DNS) and neuromodulation, a particular type of current that acts specifically on the tissue nervous and restores proper nerve functioning. This integrated approach greatly increases the positive results.