Plantar fasciitis

What causes plantar fasciitis?

You are more likely to injure the plantar fascia in certain situations. For example:

• If you are on your feet for a lot of the time during the day, or if you do lots of walking, running or standing. Also, people with a sedentary lifestyle are more prone to develop plantar fasciitis.
• If you have recently started exercising on a different, harder surface - for example, running on the road instead of on grass.
• If you have been wearing shoes with poor cushioningt.
• If you are overweight.
• If there is overuse or sudden stretching of your sole. For example: athletes who increase running intensity or distance, or poor technique.
• If you have a tight Achilles tendon. This can affect your ability to move your ankle and make you more likely to damage the plantar fascia.

Often there is no apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or 'spur' coming from the heel bone. Many people have a bony spur of the heel bone but not everyone with this gets plantar fasciitis.

How common is plantar fasciitis?

Plantar fasciitis is common. Around 1 in 10 people will get it at some time in their life. It is most common in people between the ages of 40 to 60 years, but it can occur at any age. It is more common in women than men. It is also common in athletes.

What are the symptoms of plantar fasciitis?

Pain is the main symptom, normally at one spot underneath the heel. It may be tender to press.

The pain is often worst when you first get out of bed in the morning, or after long periods of sitting down where no weight is placed on your foot. Gentle exercise may ease things, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot eases the pain.

Sudden stretching of the sole of your foot may make the pain worse - for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.

How is plantar fasciitis diagnosed?

Dr Allfree will usually be able to diagnose plantar fasciitis just by talking to you and examining your foot. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include x-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.

What is the initial treatment for plantar fasciitis?

Fascia tissue heals quite slowly, and it may take several months or more to go. Sometimes it does not resolve without treatment. The following treatments may help to speed recovery. A combination of different treatments may help, and Dr Allfree will advise you accordingly:

Rest your foot

This should be done as much as possible. Avoid running, excess walking or standing, and undue stretching of your sole.

Footwear

Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support.  Avoid old or worn shoes that may not give a good cushion to your heel.

Heel pads and arch supports

If required, Dr Allfree will provide you with pads or shoe inserts to cushion the heel and support the arch of your foot. These work best if you keep them in your shoes all the time. The aim is to raise your heel by about 1 cm.

Pain relief

Painkillers such as paracetamol will often ease the pain. Anti-inflammatory tablets such as ibuprofen can help. An ice pack  held to your foot for 15-20 minutes may also help to relieve pain. Purpose-made ice packs are available from The Mansfield Clinic.

Exercises

Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. This is because most people with plantar fasciitis have tight Achilles tendons. If this is the case, it tends to pull at the back of your heel and tends to keep the plantar fascia tight. Also, when you are asleep overnight, the plantar fascia tends to tighten up. The aim of these exercises is to loosen up the tendons and fascia above and below your heel. Dr Allfree will be able to advise you about the most appropriate exercises to do.

Are there any other treatments?

If the above treatments are not helping to relieve your symptoms, other treatments are available. There is no one specific treatment that appears to stand out as the best.

Steroid injections

A steroid  injection is sometimes tried if your pain remains bad despite the above measures. It may relieve the pain in some people for several weeks but does not always cure the problem. Steroids work by reducing inflammation. Sometimes two or three injections are tried over a period of weeks if the first is not successful. Dr Allfree has had many years’ experience in treating plantar fasciitis with steroid injections at the Mansfield Clinic. He has devised a special technique to make the procedure as painless as possible.

Extracorporeal shock-wave therapy (ESWT)

In extracorporeal shock-wave therapy, a machine is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works, but it is thought that it might stimulate healing of the plantar fascia. One or more sessions of treatment may be needed.

This procedure appears to be safe but it is uncertain how well it works. This is mostly because of a lack of large, well-designed clinical trials. 

In studies, most people who have had extracorporeal shock-wave therapy have little in the way of problems. However, possible problems that can occur include pain during treatment, skin reddening, and swelling of the foot or bruising. Another theoretical problem could include the condition getting worse because of rupture of your plantar fascia or damage to the tissues in your foot. More research into extracorporeal shock-wave therapy for plantar fasciitis is needed. Currently ESWT is performed at the Mansfield Clinic by Mr James Law.

Surgery

This may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves detaching the plantar fascia from where it connects to the bone. This is called a plantar fascia release. It may also involve removal of a spur on the heel bone if one is present. Surgery is not always successful, and it can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.

What is the outlook for plantar fasciitis?

Most people recover from an episode of plantar fasciitis within twelve months. However, some of the treatments described above may help to speed up your recovery.

Can plantar fasciitis be prevented?

There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include:

• Regularly changing training shoes used for running or walking.
• Wearing shoes with good cushioning in the heels and good arch support.
• Losing weight.
• Regularly stretching the plantar fascia and Achilles tendon.
• Avoiding exercising on hard surfaces.