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Plantar Fasciitis

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What is plantar fasciitis?

Plantar fasciitis is a common foot condition caused by chronic inflammation to the plantar fascia, caused by repetitive small tears that do not completely heal after each injury. The plantar fascia is a thick fibrous band of tissue connecting the heel to the ball of the foot and plays a vital role in supporting the arch of the foot.

Plantar fasciitis can affect anyone. It is though commoner in people who spend all day on their feet, are overweight or have altered foot biomechanics (e.g. high arched feet or flat feet). Most people with plantar fasciitis have a tight Achilles tendon, which increases the stresses on the plantar fascia.

What are the symptoms of plantar fasciitis?

The main symptoms of plantar fasciitis is pain in the heel and can spread into the arch of the foot. The pain can be described as sharp, burning or aching. The pain is usually worst whilst taking the first few steps in the morning or after prolonged sitting. Once walking around the plantar fascia loosens and the pain usually improves or subsides. Symptoms though often return after a day of standing, walking for a long time or running.

How is plantar fasciitis treated?

Plantar fasciitis is a self-limiting condition, which means it will generally resolve by itself. The average duration of the condition is around 18 months, but some people can have it for much longer. Listed below are some of the main first line treatments for plantar fasciitis but it is not exhaustive.

Appropriate footwear is recommended which is supportive, fits well and has cushioned heel pad. High heeled shoes may lead to tightening of the Achilles tendon, which can aggravate symptoms of plantar fasciitis.

Orthoses (medical insoles) can be useful to improve the foot position and reduce the forces transmitted through the plantar fascia whilst walking. You can be referred to the Orthotist for a specialist opinion.

Simple painkillers such as paracetamol, anti-inflammatory tablets (e.g. ibuprofen) or anti-inflammatory gels can be beneficial. Ask advice from your doctor or pharmacist before taking anti-inflammatory medicines as they can have side-effects in some people.

Weight-loss is an important part of the treatment plan, if you are overweight. It might be discussed as a part of your consultation. If required your general practitioner will be able to refer you onto a weight loss programme.

Activity modification aims to reduce activities that cause symptoms of plantar fasciitis. A reduction in impact activities, such as running, may be required for a specified period of time.

Stretching exercises to the calf muscles and plantar fascia is a very effective for many patients and form the mainstay of treatment to promote long term resolution of plantar fasciitis. It is important the stretching exercises are undertaken regularly. You can be referred to the physiotherapist for specialist input.

The majority (80 – 95%) of people’s symptoms will settle with time and these simple measures. It is important to be patient and stick to the treatment programme. If the pain continues further specialist treatment may be required, which includes:

Night splint to apply a constant stretch to the Achilles tendon whilst asleep. If the splints are not tolerated well at night, they can also be worn for periods of 15-30 minutes at a time, several times a day, to have a similar effect.

Steroid injection into the attachment of the plantar fascia into the heel can reduce the inflammation. The injection itself is often painful and post-injection pain may last for several days. Commonly symptoms do return after a month following the injection. Rarely a steroid injection can cause fat pad atrophy or plantar fascia rupture.

Extracorporeal shockwave therapy is offered to patients who have not responded well to other treatments. It is a procedure that passes shockwaves through the skin to the plantar fascia. The shockwaves are low energy sound waves (not electric waves) that increase the blood flow to speed up the body’s healing process.

Can you treat plantar fasciitis with surgery?

Surgery would only be considered an option as a last resort after non-surgical treatments have failed, and would depend on the extent of your condition and medical co-morbidities.

Special note

Heel pain can be caused by other conditions such as arthritis or may even be referred from your back. It may be necessary to refer you to another health practitioner if the condition doesn’t resolve or if another cause to your heel pain is suspected.

Wellbeing Advice

Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.

If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.

We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.