top of page
Search

WHAT IS PLANTAR FASCIITIS?

Updated: Jan 2


Getting pain in your heel when you get up in the morning or on getting up after being sat down for a while? Drawing pain in the heel or arch of the foot after you’ve been stood up for a while? A burning pain in the foot at night? Pain that is triggered by exercise, improves on exercising and then comes back afterwards?

You may have Plantar Fasciitis, or more accurately, Plantar Fasciopathy; as current thinking poses that pain in the plantar fascia is no longer predominantly due to inflammation of the tissue, and is instead multifactorial.

What is it? The Plantar Fascia is a band of ligamentous-type tissue which joins the heel to the base of the toes. It is there to maintain and support the arch of the foot. Plantar Fasciitis is the term used to describe microtears, and subsequent inflammation, around the Plantar Fascia’s insertion into the calcaneus (heel bone) or along the arch. Microtearing is caused by excessive load on the plantar fasciitis. The pain perceived is secondary to the inflammation.

Plantar Fasciitis

What causes it? This is variable from case to case, but some factors to consider include: - - age - gender - weight; in particular, if you have gained a significant amount of weight in a short period of time (e.g. pregnancy) - prolonged time spent on your feet (either through work or training/exercise) - the surface you spend this time on (e.g. concrete/hard surfaces) - poor footwear (e.g. thin soles, no cushioning, no fastening so foot is not stabilised inside the shoe) - biomechanics (e.g. pronation and tight calf muscles, unstable foot type) - commencing a new activity (i.e. taking up running), or upping your miles too quickly - menopause Differential Diagnoses - arthritis (osteo or rheumatoid) - a calcaneal (heel) stress fracture - tarsal tunnel syndrome - Baxter's neuropathy (impingement of calcaneal nerve) - Achille’s tendinopathy - heel pad atrophy (loss of fat pad over the heel) - osteomyelitis (infection of the bone; rare)

- heel spur (more on this below)


Diagnosis

An ultrasound scan could be helpful, but typically plantar fasciitis is diagnosed on clinical grounds. Management Treatment is centred on relieving the symptoms and identifying the underlying cause of the problem.

Relieving the Symptoms R E S T Easier said than done when we’re talking about the feet, but if you continue to weight-bear on (and therefore overload) the plantar fascia, the tissue will continue to tear and the inflammatory cycle continues.

Footwear Modification Chances are your footwear is not cushioned enough. You need shock absorbency. A decent pair of thick-soled trainers or adding a gel or foam insole and/or heel cushion to your current footwear will help. Have a think about what you are wearing at home. If you are slopping about in backless slippers, this isn't helping.


If overpronation is a factor here, an entry-level arch support may also be helpful. This will cradle the foot and prevent the full flattening of the arch during gait (normal walking), which can overstretch the lower leg muscles and contribute to plantar fasciitis. More on this below... Calf Stretches In most cases the calf muscles (gastrocnemius and soleus) are tight and effectively ‘pull’ on the plantar fascia, contributing to the microtear-effect around the heel and arch. It is important to stretch out these muscles to help relieve symptoms. Healthline has a handy 'how to' guide of stretches to help relieve plantar fasciitis. Foot Exercises There are a LOT of muscles, tendons and ligaments in your feet and we can forget that these need stretching and strengthening just like the muscles elsewhere in our bodies. These exercises are a good start. Foot wiping is also worth a go; this will help activate all the little nerve endings in your feet, reminding your brain where your feet are (which is also good for balance) and improve local circulation. DISCLAIMER: If any exercises cause new pain - or exacerbate the pain you already have - STOP DOING THEM and speak to a podiatrist. Your GP won't be able to help with this, I'm afraid! Icing Use a frozen bottle of water to massage the bottom of the foot; roll the foot over the cool bottle for a few minutes as and when required. This will help to calm the inflammation and offer some pain relief. Massage Massaging the foot encourages blood to the area and can help soothe the pain and settle the inflammation. I recommend using a product such a Tiger Balm® or Voltarol® gel. The Voltarol® has the added benefit of being an anti-inflammatory product which will help to address the inflammation caused by the microtears and allow the plantar fascia to heal. If you cannot use ibuprofen products, FlexiSEQ is a good alternative. Avoid massaging directly over the most sensitive/painful area! Pain Relief Taking paracetamol and/or ibuprofen can be helpful in the more acute stage to help relieve symptoms. Always read the instructions in the box to ensure oral pain relief is safe for you to take.

Orthotics Heel pads and arch supports may help to offer cushioning and correct over-pronation (‘rolling-in’) respectively. It is best to discuss these with a podiatrist to ensure you are not wasting your time (and money) - and you can also hurt yourself if you start tinkering with your alignment without checking-in with a professional (think knee pain, hip pain, back pain...) Shockwave Therapy Shockwave therapy is a promising new(ish) non-invasive treatment in the modern podiatrist's arsenal. However, the therapy should be used alongside other conservative treatments in order to address the underlying cause of the problem. Shockwave therapy used in isolation will not resolve plantar fasciitis long-term. The treatment (delivery of acoustic pulses through the skin) initiates a pro inflammatory response in the affected tissue that is being treated. The body responds by increasing the blood circulation in the affected area which accelerates the body’s own healing processes. It can provide a temporary pain-relieving effect on afferent nerves providing immediate analgesia known as ‘hyperstimulation anaesthesia’. Is it a heel spur? There is a high prevalence of heel spurs in the general population, and they typically don't cause any issues. There is insufficient evidence to link plantar fasciitis and heel spurs as a cause and effect. For this reason, an x-ray isn't typically indicated when looking to diagnose plantar fasciitis. If it isn't getting better... Plantar fasciitis is typically self-limiting (i.e. it will get better eventually; statistically-speaking, 90% of sufferers' symptoms will have fully resolved within 12 months), however if symptoms are unchanged, or worsening, despite following the steps above, imaging would be indicated to confirm diagnosis and onward referral to either an extended scope physiotherapist or podiatrist with a view to steroid injection, or to an orthopaedic or podiatric surgeon to consider more invasive treatment.

In Conclusion… You CAN cure Plantar Fascitiis – but you should make sure you have the correct diagnosis before pursuing any management plan. As with any musculoskeletal problem, plantar fasciitis takes time to resolve, and healing times vary from person to person.

Please get in touch for more information or you can make an appointment online here.



Comments

bottom of page