All about plantar fasciitis

Plantar fasciitis is a common condition that can affect people of all ages, especially those who practise sports or spend long hours on their feet.

Here, Mr David Redfern, renowned consultant orthopaedic surgeon who specialises in foot and ankle problems, delves into the details of plantar fasciitis, exploring its underlying causes, main symptoms, and wide range of treatment modalities.

What is plantar fasciitis?

The plantar fascia is a thick band of fibrous tissue located on the underside (sole) of the foot. It’s attached to the heel bone and extends out forward towards the toes, connecting the heel bone to the base of the toes. The plantar fascia functions like the string of a bow, helping to support the primary arch of the foot. When the plantar fascia becomes inflamed, this is then called plantar fasciitis.

What can cause plantar fasciitis?

Plantar fasciitis develops when a portion of the rigid fascia is subjected to repetitive tension, such as during extended periods of walking or running. The repetitive impact leads to an overload, resulting in microscopic tears and inflammation where the fascia attaches to the heel bone. In some cases, plantar fasciitis may be triggered by wearing improper or ill-fitting footwear.

Initially, the pain is dull and intermittent, prompting people to try and overlook the symptoms and carry on with their normal activities. However, ignoring the pain can aggravate plantar fasciitis over time, leading to sharper and more persistent pain.

In most cases, the pain is worst first thing in the morning and when standing up after prolonged sitting.

Can plantar fasciitis resolve on its own?

Plantar fasciitis resolves on its own in around 90% of people during a 12 to 18 month period. However, it’s difficult to predict how long the condition will last for each individual. Diagnosis can be confirmed through an MRI scan or ultrasound.

Treatment depends upon first confirming the diagnosis and pinpointing the underlying cause. I perform a thorough examination to rule out other potential causes of heel pain before recommending a treatment regime which is tailored to each individual.

There is no cure for plantar fasciitis. Consequently, treatment focuses on relieving symptoms while allowing the condition to settle with time.

What treatment options are available for plantar fasciitis?

I offer an integrated and multidisciplinary approach to treatment, collaborating with a team of specialists including podiatrists and physiotherapists. I tailor my advice to recommend the best treatment or combination of treatments for each individual based on their specific needs.

I offer a full range of treatments for plantar fasciitis, including:

1. Adjustment of activity

Resting and taking a break from sports is crucial to promote healing and prevent further injury. Pain should serve as a guide to determine and limit activity levels. Generally, it’s recommended to avoid activities such as running and racket sports. Cycling and swimming, on the other hand, are less likely to exacerbate pain.

2. Calf stretching exercises

People with plantar fasciitis commonly experience tightness in their calf muscles, particularly in a specific layer of muscles known as the gastrocnemii. It's thus important to perform stretches targeting this group of muscles (the medial and lateral gastrocnemius muscles) to reduce stress within the plantar fascia and promote tissue healing.

3. Physical therapy

Physical therapy can play a vital role in treating plantar fasciitis. Sports physiotherapists can oversee stretching exercises and provide additional treatments like taping, which can alleviate pain in some cases.

4. Extracorporeal shockwave therapy (ESWT)

EWST is applied to the area affected by plantar fasciitis (on the sole of the foot or heel bone), stimulating the body's natural healing response and potentially desensitising nerve endings. While EWST treatment may cause discomfort, it’s considered very safe. Treatment is usually given once a week for a minimum of three weeks and typically administered on an outpatient basis.

5. Ultrasound-guided injections

If simple interventions prove ineffective and the pain is severe, ultrasound-guided corticosteroid injections, known for their potent anti-inflammatory properties, can provide relief. These injections should only be administered by a senior physician under ultrasound guidance, given directly to the site of the tissue.

Ultrasound-guided injections provide temporary pain relief for most people, with variable durations of relief. If pain returns, additional injections can be considered, but typically no more than three injections are recommended.

6. Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as Ibuprofen or Diclofenac can alleviate pain and regularly applying ice to the painful area can also be beneficial. An easy method for icing involves rolling a chilled can of drink from the refrigerator under the affected foot.

7. Footwear recommendations

A sturdy, supportive running shoe is often the most comfortable option, but another option to consider is a shoe with a 'rocker bottom' style. It’s recommended to avoid flat, thin-soled shoes.

8. Orthotics

Off-the-shelf inner soles or cushioning heel pads, or custom-made ones crafted by a podiatrist, can be helpful.

9. Surgery

I recommend surgery in a small number of cases. Surgery isn’t typically considered unless the individual has experienced more than 12 months of persistent pain. While not the first option, there are situations where surgery can be advantageous, especially if non-operative treatments have been ineffective.

A state-of-the-art procedure that I have pioneered in the UK involves using keyhole surgery under image guidance to remove painful heel spurs. Heel spurs, in conjunction with plantar fascia, can sometimes cause heel pain. If this is suspected, I arrange an MRI scan for further investigation and discuss this operation.

More commonly, if the calf muscles remain excessively tight despite diligent stretching, I may recommend a minor surgical procedure to address the calf issue. This outpatient procedure allows people to walk immediately afterwards. Generally, postoperative discomfort is minimal with this procedure, and many people report little to no need for painkillers within two weeks following surgery.

If you require expert treatment and management for plantar fasciitis, schedule an appointment with Mr David Redfern via his Top Doctors profile today