Plantar fasciitis

Plantar fasciitis refers to pain under the heel of the foot.

The plantar fascia is a strong band of connective tissue which runs under the arch of your foot from the underside of your heel to your forefoot. The function of the plantar fascia is to provide tension across and, therefore support the arch of your foot.

Plantar fasciitis is a common condition but is more likely to affect individuals who:

  • Have poor ankle & foot alignment (termed biomechanics) such as a flattened arch
  • Have stiff calf muscles
  • Spend prolonged amounts of time standing especially if wearing unsupportive or overly firm footwear

Pain is usually located on the underside of the heel or arch of the foot. If symptoms continue over a prolonged period of time or become severe the pain may also be felt as a referred pain radiating throughout the heel bone.

Symptoms are aggravated by direct pressure to the painful area of the heel or arch of the foot. Pain increases after prolonged standing or walking. Symptoms are also typically at their most severe first thing in the morning, with the first steps of the day, after the plantar fascia has developed stiffness overnight. Pain normally settles as the morning progresses.

Plantar fasciitis can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination. The main feature on examination is often pain with direct palpation over the heel bone or the plantar fascia itself as it runs under the arch of the foot.

X-rays and scans are not routinely required.

Management

This condition can often be successfully self-managed in the following ways:

  • Avoidance of aggravating activity. Plantar fasciitis is commonly triggered by excessive weight bearing activity and reducing the time and duration of standing will help the condition improve.
  • Footwear. Lack of adequate support from footwear is another cause. It is important to wear footwear with a firm sole and adequate support to the arch, especially if the arch is flattened. Flip flops offer very little support and change to a more supportive shoe can help.
  • Weight reduction. Reducing weight will reduce forces across the plantar fascia and assist recovery.
  • Exercises. Exercises that stretch the plantar fascia and improve flexibility of the calf and plantar fascia are a mainstay of treatment.

The Arthritis Research UK website has a particularly good exercise leaflet.

5×30 second holds, 2x per day

5×30 second holds, 2x per day

  • Podiatrist. If the above measures are unsuccessful, referral to a podiatrist for advice and consideration of an insole is worth considering, especially if there are biomechanical issues. There is no evidence to suggest that custom made insoles are any more effective than those bought over the counter.
  • Physiotherapy. local treatment or taping may be helpful and can be accessed via you GP or by self-referral.
  • Night splints. although cumbersome there is some evidence that they can improve symptoms. They can be bought online
  • Time. The plantar fascia lacks blood supply and is a thick fibrous tissue. As a result, time is needed for symptoms to resolve. Do not be in a hurry to move onto invasive treatments as it is a condition that will normally resolve with time
  • Corticosteroid injection therapy. For individuals with plantar fasciitis who continue to suffer disabling symptoms in spite a course of non-surgical management, a corticosteroid injection can be offered as the next line of treatment. This injection is a very painful procedure. Its success rate is variable and often of short-term benefit. There is a small risk of tendon rupture and atrophy of the plantar fat pad so a fully informed consent is necessary before performing the procedure. You can read more about local corticosteroid injections here.

Surgery

If adequate conservative measures fail to resolve the condition, including a steroid injection a surgical release procedure can be offered, although this is rarely necessary

Useful Links

NHS choices

Arthritis Research UK

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