What is plantar fasciitis?

Heel pain is one of the most common symptoms that patients suffer with, the most common condition is plantar fasciitis. There are a number of strong ligaments, which run between the heel bone and the toes. One of these is the plantar fascia. The plantar fascia takes a lot of stress as you walk, or even just stand. In some people the plantar fascia becomes painful and inflamed. This usually happens where it is attached to the heel bone and therefore pain is felt in the heel.

What causes plantar fasciitis?

Causes include:

• Constant stress within the plantar fascia – plantar fasciitis is more common in people who spend all day on their feet. Obesity is linked to increased stress in the plantar fascia

• A tight Achilles tendon – this increases the stress on the heel. Most people with plantar fasciitis have a rather tight Achilles tendon

• People who have high-arched (‘cavus’) feet or flat feet are less able to absorb the stress of walking and are at risk of plantar fasciitis

• Occasionally plantar fasciitis starts after an injury to the heel

• People who have a rheumatic condition such as rheumatoid arthritis or ankylosing spondylitis may get inflammation anywhere a ligament is attached to bone (enthesopathy), and plantar fasciitis in these people is part of their general condition

What are the symptoms of plantar fasciitis?

The classic symptom is pain first thing in the morning when getting out of bed, the pain is initially in the heel but can spread along the foot. The pain can also be worse when first standing after a period of rest and can sometimes ease with activity. Patients often also complain of pain at the base of the heel at the end of the day after prolonged periods of time on their feet.

Having had plantar fasciitis myself, the pain experienced can be severe and disabling. Thankfully, most of the time this condition does settle on its own with simple nonsurgical treatments. However, there are some cases where symptoms are prolonged and severe and can really impact on life and activities.

What are the treatments for plantar fasciitis?

The vast majority of cases are treated without an operation. Usually the longer the symptoms have been present, the longer they will take to settle down. A combination of non-surgical treatments is generally required. Over 90% of patients improve with simple non-operative treatments, however it can take a few months for the symptoms to settle.  Simple non-operative treatments include:

• Weight loss – this will reduce the amount of stress on the plantar fascia. Even small amount of weight will be magnified through the foot
• Activity modification – avoid strenuous and high-impact exercise to settle the acute symptoms
• Manual therapy such as tolling a tennis ball or a cold soft drink can under the heel
• Painkillers and anti-inflammatories
• Physiotherapy – Specific physiotherapy exercise is one of the main treatments which has been shown to predictably improve pain symptoms, but need to be performed regularly as instructed
• Night splints – These are used to continue stretching the plantar fascia and/or calf tendons during night time as our feet naturally point downwards when we sleep
• Insoles/heel pads – Shock absorbing heel pads or special insoles can help with the sharp pain

If the above simple measures do not work then more specialised treatment is available:

• Shock wave therapy – Studies have shown good results with reduction in pain. Physiotherapy stretches must be done in conjunction with this
• Steroid injections – An injection of steroid could be considered. There is a small risk of infection, increased pain, thinning of the heel pad and plantar fascia rupture
• Further physiotherapy – it is important to continue stretches in combination with other treatments

Over 90% of cases are improved and settle with a combination of non-surgical methods. In cases where nonsurgical methods have not worked satisfactorily, it is advisable to see a specialist for further tests and discussion with regards to other treatment options.

To book an appointment to see Mr Ieong, or one of our other highly experienced Orthopaedic surgeons, simply complete the contact form here or call 01442 331 900.