Plantar Fasciitis, Plantar Fascia Pain, Heel Pain

Plantar fasciitis (“plarn-tar fashy-eye-tiss”) is one of the most common musculoskeletal conditions affecting the feet. If you wake up one morning, put your foot down and suffer a sudden, agonizing pain in your heel, a really sharp pain, then you’ve got plantar fasciitis.

Typically the pain of plantar fasciitis is very sharp and located on the sole of the foot under the middle of the heel. The problem can be associated with a heel spur, a bony outgrowth under the heel where the plantar (sole) ligament inserts.

What Happens In Plantar Fasciitis?

Plantar fasciitis is thought to be the result of increased stretching stresses on the plantar fascia/ligament where it inserts into the heel spur area. The repeated pulling stresses can cause multiple micro-traumas to the insertion area, resulting in chronic inflammation of the region.

Repeated damage and inflammation in this area can cause acute pain, especially with the first steps after getting up from a chair or from bed.

Problems Caused By Plantar Fasciitis

In bad cases people can have worsening and quite disabling pain in the heel part of the sole, causing a limp and restricting functional activities such as running and walking.

How Plantar Fasciitis Pain Behaves

An unexpected, very sharp and unpleasant pain in the heel is the first thing most people know about getting plantar fasciitis. This is the main symptom. The pain is worst during the first few steps after getting up from resting such as sitting or sleeping, then eases to a repeated, but less severe pain on walking.

Taking weight off the foot is the only relieving factor for the symptoms and people can be worse at the end of the day if they are on their feet a lot. A new activity taken up such as running or a change in typical footwear can be risk factors for developing plantar fasciitis.

Investigations For Plantar Fasciitis

There are no diagnostic or especially useful investigations for plantar fasciitis. X-rays of the foot, particularly from the side, may show the heel spur resulting from this condition. In some cases bone scans and CT scans may be used but these would be specific requests from an orthopaedic specialist.

Treatment For Plantar Fasciitis

Physiotherapy is the main treatment for this condition.

• Stretching is an important treatment. If the pain is bad in the morning the foot can be stretched up by putting a towel under the forefoot and pulling up with the hands. Standing calf stretches and a night splint to hold the foot up in a partly stretched position can also be useful.
• Deep massage along the plantar fascia may be useful and can be done by the sufferer once shown how by a therapist.
• Ice can reduce both pain and inflammation, used from 10 to 20 minutes as an ice pack. Use care with ice and ensure your skin is protected. Do not put a freezing pack directly on your skin as this can cause frost-bite like damage.
• Taping can be used by a therapist or trainer to attempt to route some of the forces through the sole along a different line.
• Advice on activity modification is important as the condition may not completely resolve. Patients may need to consider alternative methods of keeping up their aerobic fitness and strength if weight-bearing activity is too painful.
• Shock absorbing heel pads can be useful and should be tried as soon as the condition presents. Silicone gel pads are commonly used and are relatively cheap.
• Arch supports may also be useful to restore more normal foot mechanics in cases where this has been disturbed.

Medical And Surgical Treatments

Surgery is rarely necessary but the plantar fascia can be released from its insertion under the heel bone, similar to the operation to release tennis elbow.

• Other treatments commonly used are corticosteroid injections, shockwave therapy and botulinum (botox) injections.

Prevention

• Education can be an important means of preventing or reducing the impact of plantar fasciitis. The appropriateness of sports shoes for runners and other sporting people should be reviewed and optimized for their particular sport and mechanical needs.
• Orthotics can be prescribed to improve the mechanics of the feet and allow someone to perform at a higher level.
• Specialist footwear can be considered for work-related foot problems.