How to prevent heel pain (plantar fasciitis)

Heel pain is one of the most inconvenient injuries you can experience and more often than not, the cause is plantar fasciitis. Leading orthopaedic surgeon, Mr Barry Rose is here to tell you more about this condition.

What is plantar fasciitis?

One of the most frequently cited causes of heel pain, plantar fasciitis, is a condition where small tears occur in the plantar fascia, the ligament which connects your heel to your toes.

Although the cause of plantar fasciitis often remains unclear in many cases, some of the known possible factors include overstretching the ligament, increased load due to obesity, standing for long periods of time or strenuous exercise. Tight calf muscles can also contribute to plantar fasciitis, with eighty-three per cent of individuals with plantar fasciitis also experiencing it.

What are the main symptoms?

Tears in the plantar fascia cause inflammation and pain in the heel bone and the sole of the affected foot, which subsequently result in discomfort and difficulty walking or standing.

It has been widely reported that the pain caused by plantar fasciitis is typically worse in the morning, particularly with the first step (known as start-up pain). This occurs due to the fact that both the Achilles tendon and the plantar fascia tighten during sleep. The pain generally alleviates during the day, often getting worse towards the evening or after strenuous exercise.

Who is most likely to develop plantar fasciitis?

Plantar fasciitis typically affects those over sixty years old, while women are more susceptible than men. Additionally, overweight individuals are more likely to develop plantar fasciitis, due to the extra strain placed on the feet Diagnosis of this condition is usually based on examination via MRI as well as an assessment of your medical history, lifestyle and habits.

How can someone prevent plantar fasciitis?

Evidence indicates that plantar fasciitis usually resolves itself after up to 18 months. While it can be difficult to pre-empt such a condition, once pain is felt initially, there are steps you can take to stop it from worsening. Stretching of both the calf muscle and the plantar fascia has been proven extremely effective in preventing the condition from worsening. Wearing comfortable shoes and even cushioned insoles are also recommended. Wearing a night splint, which holds the ankle in a stable position during sleep, has also been proven to be effective in preventing the overnight tightening of the plantar fascia.

What is the best treatment for the condition?

In nine out of ten cases plantar fasciitis will heal without the need for an operation. For those experiencing severe pain and discomfort, steroid injections may be offered as a solution. However, this treatment isn´t usually recommended as there are few long-term benefits and repeated injections can damage the area further. Shockwave Therapy (ESWT) may be suggested to some patients as an alternative to steroid injections.

Surgery is generally only considered once a minimum of six months have passed from the first sign of symptoms and all other options have been explored. For overweight or obese individuals, surgery only be suggested as a last resort if the condition doesn’t improve after weight loss. The procedure can be done under local or general anaesthesia and usually consists of releasing the tension in the calf muscle.

 After the operation, patients are encouraged to stretch regularly in order to prevent tightness in the affected area and to keep their weight down to reduce the stress on the plantar fasciitis.

Mr Barry Rose is a consultant orthopaedic surgeon with over 15 years of experience, who specialises in foot and ankle surgery. Visit his profile to request an appointment with him.