What is plantar fasciitis?
Plantar fasciitis is a common condition which causes heel pain. It occurs when the thick band of tissue (the plantar fascia ligament) that connects your heel bone to your toes becomes inflamed or irritated. The plantar fascia is designed to support the arch of your foot but when under constant strain, it can develop small tears.
Common signs and symptoms of plantar fasciitis
Plantar fasciitis typically causes a stabbing pain in the bottom of your foot. The pain is usually:
- Located nearer to the heel of your foot
- Worse in the morning when you first take steps after waking
- Triggered after standing for a long time or getting up from sitting
- Worse after exercising
Common causes of plantar fasciitis
When the plantar fascia ligament is strained, small tears can occur. Repeated tears can result in inflammation. The exact cause of such tears is not clear, but there are certain risk factors that may increase your chances of developing plantar fasciitis, such as:
- Being aged between 40 to 60
- Engaging in certain activities that put a strain on the heel and bottom of the foot (i.e. ballet, jumping, long distance running)
- Having any foot or gait abnormalities, such as being flat footed or having a different pattern of walking
- Obesity putting additional strain on the feet
- Standing for long hours
Diagnosing plantar fasciitis
To reach a diagnosis, your doctor will examine your foot to determine where your pain is located. A physical examination alone is usually enough to diagnose plantar fasciitis but occasionally your doctor may refer for scans such as an x-ray or Magnetic Resonance Imaging (MRI) test. These types of scans can help your doctor to rule out a fracture or a pinched nerve.
Treating plantar fasciitis
Rest, along with self-care treatment (icing the area) is usually enough to help plantar fasciitis to heal over time. Medication and certain therapies can assist in the process.
Over the counter pain relief such as anti-inflammatories, pain-killers etc can help with pain management and inflammation.
Exercises or the use of devices may provide symptom relief. These include:
- Physiotherapy – A physiotherapist will be able to show you how to stretch the plantar fascia and build up the muscles in your lower legs. Increased muscle strength in this area can provide better stability in the ankle and heel. You may also be shown how to apply athletic tape to support your foot.
- Night splints- Night splints help to keep your foot stretched out during the night.
- Orthotics – If you have high arches or flat feet, orthotics might be recommended. These are custom made inserts that fit into your shoes and help to support your feet.
If conservative treatment has failed to improve symptoms, your doctor may recommend some invasive treatment options:
- Steroid injections. These injections can provide temporary relief but are not recommended for long term use due to risks of the ligament rupturing.
- Extracorporeal shock wave therapy (ESWT).This is a type of treatment which uses sound waves to promote healing is usually only recommended for chronic cases of plantar fasciitis. It can cause minor side effects such as bruising, swelling, pain, numbness or tingling. Whilst it has been shown to be effective in some cases, it has not been found to be consistently helpful.
- Ultrasonic Therapy. This is a minimally invasive procedure using ultrasonic energy to precisely treat only the damaged tendon tissue.
- Surgery. Rarely carried out but may be required when symptoms are severe and all other treatment has failed. You may be left with weakness in the arch of your foot after this surgery.
Recovering from plantar fasciitis
Plantar fasciitis can be slow to heal and it can take up to 6 months for symptoms to go away. Recovering from this condition involves following the recommendations from your doctor or physiotherapist and avoiding activities or risk factors which may cause the problem to flare up again.