Pain and Difculty Level in Working Females having Plantar Fasciitis of Multan City

A cross-sectional study was conducted on 150 working females of Multan having plantar fasciitis, to �nd out the level of pain and di�culty. The duration for this study was six months after the approval of the synopsis. The working ladies of age 30-50 years having a minimum of �ve years of experience, were selected to �gure out the pain and di�culty level that is present. Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. The plantar fascia plays an important role in the normal biomechanics of the foot and is composed of three segments, all of which arise from the calcaneus. The fascia itself is important in providing support for the arch and providing shock absorption [1]. Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year [2]. In America, two million people receive the treatment for plantar fasciitis each year When plantar fasciitis occurs, the pain is typically sharp and usually unilateral (70% of cases). Bearing weight on the heel after long periods of rest worsens heel pain in affected individuals. Individuals with plantar fasciitis often report their symptoms are most intense during their �rst steps after getting out of bed or after prolonged periods of sitting. Symptoms typically improve with continued walking. Common symptoms include numbness, tingling, swelling, radiating pain. Typically, there are no fevers or night sweats Since in�ammation a lesser Plantar fasciitis is an in�ammation of the plantar fascia that is most commonly seen in the working population with prolonged standing and inappropriate shoe wear. Plantar fasciitis is presented with heel pain, resulting in disturbances of activities of daily life. Objective: To determine the pain and di�culty level in working females of Multan having plantar fasciitis. This will help them in reducing pain and di�culties by reducing risk factors that can cause plantar fasciitis. Methods: A cross-sectional study was conducted with 150 working females of Multan having plantar fasciitis. Data were collected through the plantar fasciitis pain scale, visual analogue scale, and windlass test. Data were obtained non-randomly from different working places of Multan. (Hospitals, Schools, Colleges, Salons, and Malls). 150 respondents were of age group 30-50 years were included in the study. Results: The pain and di�culty level in working females of Multan having plantar fasciitis was 72%. Surface pain was 46% and deep pain was 54%. 34% of subjects suffer from pain throughout the day with regular intervals. 18% had pain only when they �rst get up. 67% of women feel comfortable walking on toes while 33% feel uncomfortable. Pain interferes with athletics and weight-bearing activities of 53% of women. Conclusion: The pain and di�culty level in working females of Multan having plantar fasciitis is 72%. It increases with an increase in associated risk factors, such as prolonged standing, long working hours, inappropriate shoe wear, and postural malalignment.

degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year [2]. In America, two million people receive the treatment for plantar fasciitis each year [3]. When plantar fasciitis occurs, the pain is typically sharp and usually unilateral (70% of cases). Bearing weight on the heel after long periods of rest worsens heel pain in affected individuals. Individuals with plantar fasciitis often report their symptoms are most intense during their rst steps after getting out of bed or after prolonged periods of sitting. Symptoms typically improve with continued walking. Common symptoms include numbness, tingling, swelling, or radiating pain. Typically, there are no fevers or night sweats [4]. Since in ammation plays either a lesser

I N T R O D U C T I O N
Plantar fasciitis is an in ammation of the plantar fascia that is most commonly seen in the working population with prolonged standing and inappropriate shoe wear. Plantar fasciitis is presented with heel pain, resulting in disturbances of activities of daily life. Objective: To determine the pain and di culty level in working females of Multan having plantar fasciitis. This will help them in reducing pain and di culties by reducing risk factors that can cause plantar fasciitis. Methods: A cross-sectional study was conducted with 150 working females of Multan having plantar fasciitis. Data were collected through the plantar fasciitis pain scale, visual analogue scale, and windlass test. Data were obtained non-randomly from different working places of Multan. (Hospitals, Schools, Colleges, Salons, and Malls). 150 respondents were of age group 30-50 years were included in the study. Results: The pain and di culty level in working females of Multan having plantar fasciitis was 72%. Surface pain was 46% and deep pain was 54%. 34% of subjects suffer from pain throughout the day with regular intervals. 18% had pain only when they rst get up. 67% of women feel comfortable walking on toes while 33% feel uncomfortable. Pain interferes with athletics and weight-bearing activities of 53% of women. Conclusion: The pain and di culty level in working females of Multan having plantar fasciitis is 72%. It increases with an increase in associated risk factors, such as prolonged standing, long working hours, inappropriate shoe wear, and postural malalignment.

A R T I C L E I N F O A B S T R A C T
surgery. Methods include rest, Over-the-Counter (OTC), Nonsteroidal Anti-In ammator y Drugs (NSAIDs), stretching, counter-strain technique, or thoses, corticosteroid injections, Extracorporeal Shock Wave Therapy (ESWT), and ultrasound therapy [2]. The natural history of PF is often self-limited and resolve in 80% of the patients with-in 1-4 years regardless of the treatment [13,14]. What makes the patients seek medical attention is either the irritation or the incapacitating pain at the time of an attack. For that, trial of conservative therapies is advised before more invasive treatments are attempted [8,15].

M E T H O D S
or no role, a review proposed it be renamed as "Plantar Fasciosis" "Painful Heel Syndrome", "Runner's Heel", "Tennis Heel", "Calcaneal Peritonitis", and "Heel Spur Syndrome". During normal circumstances, the plantar fascia acts like a biomechanical shock absorber, supporting the arch in the foot but, if the tension on the plantar fascia exceeds the limits of the tissue, small tears can develop in the fascia. Repetitive tension, stress, and subsequent tearing can cause the fascia to become in amed and painful. Plantar fasciitis is regarded as a self-limiting disease, and over 90% of patients will be cured within 6 months with nonoperative scenarios [5]. Laboratory investigation performs to rule out underlying endocrine and in ammatory conditions. X-rays are required to rule out other causes of heel pain, speci cally calcaneal stress fractures and not calcaneal spur, as its rules in the pathogenesis of PF are controversial [6,7]. MRI is performed in patients who are resistant to treatment, to exclude alternative diagnoses that were not observed on the X-ray, such as a calcaneal stress fracture, calcium deposit, or soft-tissue tumor. Ultrasonography is the study imaging of choice due to its low cost when the diagnosis of plantar heel pain is unclear, but it requires a specialized training personal [8]. Between 4% and 7% of the general population has heel pain at any given time about 80% of these are due to plantar fasciitis [9]. Approximately 10% of people have the disorder [10]. Conservative treatment includes: physical treatment such as low dye strapping, therapeutic orthotic insoles, orthotic devices, night splints, Achilles and plantar fascia stretching; pharmacotherapy such as oral in ammatory medication, cortisone injections, and botulinum toxin injections. Treatment should start with stretching of the plantar fascia, ice massage, and nonsteroidal antiin ammatory drugs. Many standard treatments such as night splints and orthoses have not shown bene t over placebo. These days, the treatment options available include autologous plasma transfusions, corticosteroid injections, physiotherapy-like strength training, and Extracorporeal Shock Wave Therapy (ESWT). Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures, although evidence is lacking. Endoscopic fasciotomy may be required in patients who continue to have pain that limits activity and function despite exhausting nonoperative treatment options. ESWT is comparable to surgical plantar fasciotomy without any operative risks and yields good long-term effects [11,12]. Effective treatment is predicated on the modi cation of risk factors and the implementation of an evidence-based treatment approach. Ultimately, a good prognosis is expected. Approximately 85% to 90% of patients with plantar fasciitis can be successfully treated without A cross sectional study was conducted in general population of Multan city. The study was completed within "6 months" after the approval of synopsis. Sample selection was based upon the inclusion and exclusion criteria. The sample size was taken by using the non-probability purposive sampling technique. The sampling tools were the plantar fasciitis pain/disability scale, visual analogue scale, and windlass test. Inclusion criteria; working females of 30 to 50 years' age with minimum 5 years of working experience. Exclusion criteria; presence of fracture in foot bones, recent surgery of foot, mentally unstable working ladies, having musculoskeletal disorders and other comorbidities, pathological disease, osteoporotic females, and congenital diseases of foot. On the initial appointment the patients were assessed to rule out the possibility of presence of any of the signs mentioned in the exclusion criteria. After that they were requested or offered to participate in the study. A detailed consent form was duly signed by each patient willing to participate in the study and the lled out plantar fasciitis pain/disability index questionnaire. The main aim of the study is to search out pain and di culty levels in working females having plantar fasciitis. This study can facilitate in reducing pain and di culties in those operating females having plantar fasciitis.

R E S U L T S
The pain and di culty level in working females of Multan having plantar fasciitis is 72% above age group 50. Signs and symptoms of plantar facilities increased with prolonged standing and relieved by rest. Surface pain was 46% and deep pain was 54%. 34% of subjects suffer from pain throughout the day with regular intervals. 18% women have pain only when they rst get up. 67% of women feel comfortable walking on toes while 33% feel uncomfortable. Hence, it is comfortable to walk on toes than walk at footed for patients. Pain interferes with athletics and weight-bearing activities of 53% of women. The associated risk factors account for pain and di culty in working Thus by concluding this study, it is found out that pain and di culty level in working females having plantar fasciitis increases (72%) with age as in this study, above 50 years of age. Women are having more troubles in facing prolonged standing (49%), walking (14%), and running (11%). Pain level was intense when they took their rst step in the morning and during long standing working hours. Obesity (8%), inappropriate shoe-wear (10%), and postural abnormalities (18%) may in uence di culty level. Hence, we can improve and reduce pain and di culty level by keeping in mind the above mentioned risk factors and taking precautionary measures accordingly.

D I S C U S S I O N
This present study was conducted to determine pain and di culty level in working females of Multan having plantar fasciitis. Previous studies report that plantar fasciitis is common with prolonged standing and weight-bearing tasks like running and walking and as the duration of these activities increases, a cross-sectional study by Robert and his colleagues "Risk Factor of Plantar Fasciitis among Assembly Plant Workers" working at least for last 6 months with full-time employment. It was concluded that as time spent standing increases the prevalence of plantar fasciitis increases. In the current study, we selected working females who spent most of their time standing inappropriately with postural mal-alignment. Plantar fasciitis is commonly present with heel pain. The research was conducted in 2015 to nd out the prevalence and risk factors of plantar fasciitis in heel pain patients.  T h ey we re a l s o s e e n u s i n g a n a l g e s i c s fo r p a i n management. In this study we have observed only working females with 150 working size. We have studied women both with obese and lean body mass. Rasenberg N. et al, conducted a research on "Incidence, Prevalence, and Management of Plantar Heel Pain". A retrospective cohort study in "Dutch Primary Care". The overall incidence PHP was 3.83 cases per 1000-year. The incidence of female was 4.64 and of males was 2.98. Overall prevalence of PHP was 0.4374%. The incidence of PHP was seen on its peak in September and October of each year [18].