Plantar Fasciitis

What is Plantar Fasciitis?

Plantar Fasciitis is when you get pain at the bottom of the foot, usually near the heel, but it can extend up towards the greater toe. This pain can occur when getting out of bed or when walking.

How do I know if I have it?

The pain can extend from the heel to the greater toe and sometimes is associated with Achilles tendinitis and so up the back of the leg. It is usually worse first thing in the morning, sometimes during walking or standing for long periods.

How does this happen?

It is not clear why this occurs, though there are several associations. A sudden increase in activity (i.e. people who have started running when the hadn’t previously), overweight people, non-supportive footwear or worn footwear, being middle aged and competing in higher risks sports such as dancing or aerobics. People with high arches are also at high risk.

What is the pathophysiology?

The plantar fascia is an aponeurosis of connective tissue that attaches to the calcaneus and then divides into 5 connections for each toe. This provides support to the arch of the foot. Biopsy’s of the plantar fascia taken at surgery show degenerative changes histologically and fibroblastic changes. Inflammatory changes are not always present.

How do I fix it?

The approach to treatment is varied and reflects the ambiguous causes of plantar fasciitis. If provoking factors can be identified – increase in activity, poor footwear or being overweight, addressing these issues may reduce the symptoms.

Initially the following is recommended:

• Stretches can be provided by your GP or physio
• Use of supportive shoes or purchase supportive innersoles with gel heels.
• Exercising in shoes or on soft surfaces only
• Reduce the amount of the causative activity and rebuild the quantity of exercise slowly
• NSAID’s, if suitable for you can provide some relief
• Ice the area following exercise

If this does not provide any relief after about 2 -4 weeks, then discuss with your GP. They may arrange for an ultrasound and an x-ray to exclude other causes.

They then may discuss other treatment options:

• Night braces
• Orthotics developed by a podiatrist
• Physiotherapy for exercises and strapping
• Steroid injection
• Plasma Rich Protein injections
• Shock wave therapy
• Surgery is rarely considered and only complete in severe unremitting cases.