Family doctor

Key points:

• Plantar fasciitis is a very common cause of heel pain.

• Plantar fasciitis is caused by accumulated damage to the plantar fascia that runs along the bottom of the foot.

• Over-exercising, inappropriate footwear, and standing for extended periods of time are common risk factors for developing plantar fasciitis.

• The cornerstone of treating plantar fasciitis is reducing the amount of time spent on the affected foot. Reduce activities such as running, excessive walking and standing. Wearing appropriate footwear may also be helpful.

• Stretches, exercises, orthotics, paracetamol, and/or anti-inflammatories may be helpful in treating plantar fasciitis.

• Corticosteroid injections and surgery are treatment options reserved more severe plantar fasciitis that hasn’t responded to general treatment.

• In most cases plantar fasciitis takes up to 6 months to fully heal.

What is plantar fasciitis?

Plantar fasciitis is the most common cause of heel pain. Plantar fasciitis is the medical term used to describe the inflammation of a tough connective tissue band that runs along the sole of the foot. This tough band of tissue is called the plantar fascia. The plantar fascia runs from the heel bone to the base of the toes and spreads out in a fan-shape.

The plantar fascia contracts and stretches as the foot moves. It has a number of functions. These include; stabilizing joints of the foot when the foot comes into contact with the ground, acting as a shock absorber for the leg, and a contribution to forming the arch of the foot.

It is thought that plantar fasciitis develops as a result of numerous small tears developing in the plantar fascia. These tears are thought to result from repetitive trauma that leads to inflammation and subsequent heel pain.

What causes plantar fasciitis?

There are a number of things that can contribute to the development of plantar fasciitis. Overall it is thought that inflammation in the plantar fascia develops because of small tears in the plantar fascia itself. Generally things, which increase the amount of stress there is on the foot, are those that increase your likelihood of developing plantar fasciitis.

These include:

• Wearing incorrect footwear.

• Increasing physical activity too quickly. Generally physical activity that puts a lot of stress on the feet in general is the most likely to cause plantar fasciitis. Running, jumping, dancing, and walking are prime examples.

• Changing the primary surface you exercise on e.g. changing between road, grass, and sandy surfaces.

• Being on your feet for long periods of time (i.e. at work).

• Having tight calf muscles.

• Having either high arched or flat feet.

• Poor biomechanics or poor running/walking technique. This places extra tension on your plantar fascia.

Who is more at risk of getting plantar fasciitis?

• Women are more likely to get plantar fasciitis than men.

• Those who are overweight are more likely to develop plantar fasciitis, as the extra weight puts more stress on the plantar fascia.

• Athletes in sports where a lot of running, jumping, or dancing is required are at higher risk.

What are the symptoms of plantar fasciitis?

• Heel pain (usually in just one foot, but can be in both feet at the same time).

  • Most severe in the middle of the heel. This pain can also radiate through the sole of the foot.

  • Worse when walking first thing in the morning or after a period of rest.

  • May decrease with walking.

  • May be worse when walking bare foot or walking up stairs.

Plantar fasciitis is often associated with bony spurs called calcaneal spurs. These are seen on X-ray. These develop as a result of plantar fasciitis because bone can get deposited where the plantar fascia has been damaged the most. They do not cause plantar fasciitis but are instead a result of the damage present in plantar fasciitis.

How does plantar fasciitis get diagnosed?

In most cases plantar fasciitis is a clinical diagnosis. This means that after examining your foot and hearing about your heel pain, how it has developed, and what your different risk factors might be your doctor will be relatively confident of a diagnosis of plantar fasciitis.

Usually no investigations are required to diagnose plantar fasciitis. If your doctor is concerned about ruling out other diagnoses they may get want you to have investigations. An example of this would be an X-ray to rule out a stress fracture.

What treatments are available for plantar fasciitis?

There are a number of different ways to try and treat plantar fasciitis. Not all treatments are effective in all people. Unfortunately fasciae are slow healing and so patience in dealing with plantar fasciitis is key. Combining a number of different treatments may help speed your recovery.

General measures to help:

• Rest your foot as much as possible. Avoid undue stress on the affected foot. Avoid running, excessive walking or standing.

• Wear appropriate footwear with good cushioning and arch support.

• Avoid walking barefoot on hard surfaces.

• Heel inserts and orthotics may be useful.

• Regular gentle stretching of your plantar fascia and Achilles tendon may be helpful. Examples of these exercises are readily available from many online sources. A physiotherapist will best be able to give you a series of stretches and exercises to help.

Medications and other treatments that can help:

• Paracetamol may be useful in reducing pain.

• Anti-inflammatory drugs such as ibuprofen and diclofenac can be useful. These medications reduce pain and reduce inflammation.

• Steroid (cortisone) injections may be helpful. This involves an injection directly into the area where pain is being felt. These are only used if the pain is more severe and general measures along with pain relief are not helping. Steroid injections reduce inflammation. These are not always successful, and even in instances where they do relieve pain the pain can recur after several weeks.

• Surgery is sometimes used in more severe cases where other treatment has not worked. The surgery involves partial release of the plantar fascia from the heel bone to relieve tension. There are risks associated with surgery and it is not always successful. This should be thought of as a last resort for plantar fasciitis.

How long does it take for plantar fasciitis to heal?

Plantar fasciitis can take up to a year to fully resolve. In saying this ~75% of cases are fully resolved within 6 months.

What can I do to avoid getting plantar fasciitis?

There are a number of measures you can take to avoid developing plantar fasciitis. These include:

• Strengthening the muscles of your feet and lower leg. There are a number of exercises that can be done to achieve this e.g. calf raises, toe curls, and others.

• Regular stretching of the Achilles tendon and plantar fascia.

• Maintain a healthy weight.

• Warm up before undertaking physical activity.

• Avoid over-training. If increasing the amount you are running and/or walking do so in a graduated manner over a period of weeks-months.

• Avoid walking and/or running on hard surfaces (e.g. pavement) if you know you are prone to getting heel pain.

• Avoid or reduce exercising if muscles in your legs are tight or sore.

• Wear appropriate footwear. Quality pair of shoes for exercising and for whilst at work to help reduce the amount of stress on the plantar fascia.

• Orthotics can also be helpful. This is especially true in individuals with flat feet or high arches.