Plantar fasciitis: How is pain relieved?

Plantar fasciitis is a common source of heel pain. Here to provide an expert insight into plantar fasciitis, including symptoms, risk factors and treatment, is Mr Vail Karuppiah, leading consultant orthopaedic foot and ankle surgeon.

What is plantar fasciitis?

Plantar fasciitis is a condition caused by the inflammation of the plantar fascia, the thick band of tissue on each foot that connects the heel to the base of the toes.

The plantar fascia supports and holds the arch of the foot in place. Certain movements, however, subject the plantar fascia to excess stress and tension, causing small tears to appear. With repeated tears and stretches, the fascia becomes inflamed or irritated, causing pain. This is called plantar fasciitis.

What are the symptoms of plantar fasciitis?

The main symptom of plantar fasciitis is a stabbing pain that is felt near the heel, at the bottom of the foot. The pain is usually felt first thing in the morning, as soon as people get out of bed and they take their first few steps. In addition, people might also experience pain after long periods of standing or after standing up from a sitting position. The pain typically worsens after exercise.

What are the causes of plantar fasciitis?

The exact cause of plantar fasciitis isn’t always clear, but certain factors can increase the risk for the condition.

Age: Plantar fasciitis is more prevalent among people who are 40 to 60 years old.

Type of exercise: Certain activities subject the heel and the attached issue to increased stress, leading to the earlier development of plantar fasciitis. These activities include: long-distance running, ballet dancing, ballistic jumping activities, and aerobic dance.

Characteristics of the foot: Certain features can affect how weight is distributed when standing and also put increased stress on the plantar fascia. These features include: having flat feet, having a high arch, having an abnormal walking pattern.

Obesity: Excess weight places added stress on the plantar fascia.

Job: People in certain occupations are more at risk of hurting their plantar fascia. These include: factory workers, policemen, teachers, and people who walk or stand on hard surfaces for the majority of their working hours.

As well as this, shoes that don’t have proper support can also increase the risk for plantar fasciitis.

How is plantar fasciitis diagnosed?

Plantar fasciitis is diagnosed during a clinical examination. Although no specific tests are required, X-ray or MRI scans are sometimes ordered to rule out other causes of pain.

What are the different treatment options available for plantar fasciitis?

Initial treatment for plantar fasciitis consists of pain-relief medication and physiotherapy, with focus on stretching exercises for the plantar fascia and the Achilles tendon.

If plantar fasciitis doesn’t respond to conservative measures, steroid injections or platelet-rich plasma injections in the plantar fascia can provide (temporary) pain relief. Shockwave therapy has also shown promising results in studies when used for plantar fasciitis.

Role of Surgery

If the pain persists, keyhole surgery may be recommended to detach the plantar fascia, relieving stress and tension.

The risks of surgery are small as the procedure is done using special instruments with a small cut in the skin.

Risks typically include:

• infection in the wound
• leg or lung clots
• swelling in the foot and ankle, which may last for up to three months
• scar hypersensitivity
• injury to the main nerves or blood vessels around the surgical area
• temporary or permanent numbness around the surgical area

Very rarely, people may experience chronic pain post-surgery, loss of a limb or risks involved with the anaesthetic.

The surgery is performed as a day-case procedure under anaesthesia. Following surgery, people will need to walk in surgical shoes for two weeks and attend clinic follow-up appointments. Some people may need crutches during the first couple of weeks.

Most people are able to return to their normal activities, including driving, two to four weeks after surgery. Discomfort and swelling may be experienced up to three months following surgery, but this shouldn’t be a cause for concern.

If you require expert treatment and management for plantar fasciitis, don’t hesitate to visit Mr Karuppiah’s Top Doctors profile today.