What is plantar fasciitis?

The plantar fascia is a strong band of tissue that supports the arch. Plantar fasciitis is the name given to a condition that affects the plantar fascia.

Plantar fasciitis is a common problem, particularly for those over 40 and overweight. It is thought to be caused by irritation at the point where the plantar fascia, a strong band of tissue that supports the arch of the foot, connects with the heel bone. Small tears may also occur along the plantar fascia which will later form scar tissue.

What causes plantar fasciitis?

When we stand, the whole of our body weight passes through our feet and the arch flattens, pulling on the plantar fascia attachment at the heel. When we walk, our feet roll, in flattening the arch even more. Furthermore, with each stride, our whole weight is supported by just one foot at a time.

As we age, our joints get stiffer, the fatty padding under our feet gets thinner, and the tendons, ligaments and plantar fascia lose their ‘spring’. This means our feet are less able to adapt to increased strain, such as putting on weight or overexertion.

Our feet are designed to work in a particular way when we walk, rolling in (pronating) and out (supinating) with each step. Our whole body is involved in the process, particularly our back, hips, knees and ankles. Any problems affecting these joints or the muscles that move them will have an adverse affect on the way we walk, putting further strain on our feet. Tight muscles are a common cause of plantar fasciitis.

What are the symptoms of plantar fasciitis?

• Pain on the bottom of the heel which may increase over a period of months.
• Pain that is typically worse after resting (especially first thing in the morning) but eases off after a few minutes of walking. The pain may return after spending long periods of time on your feet.

How is plantar fasciitis treated?

There are many ways you can self manage your symptoms:

Exercises

Exercises that stretch the calf muscle and plantar fascial band help ease pain and assist with recovery.

Calf stretches

Stand with your hands against a wall. Take a step back with one leg. Make sure your heel is on the floor and the knee straight. You can bend the front knee if you want to increase the stretch.

Plantar fascia stretches

Pull your toes back towards your shin whilst also flexing the ankle.

Hold this for 30 seconds and repeat three times.

Footwear

A good supportive shoe with a fastening, such as a trainer, may help. Avoid completely flat shoes.

Medication

Your pharmacist will be able to recommend an appropriate painkiller for you.

Ice

Putting an ice pack on your heel for five minutes during the day helps reduce inflammation. Place a towel between the ice and your heel. Do not apply ice directly to the skin.

Lose weight

Weight loss will reduce the strain on the plantar fascia.

Other treatments that may be provided by your podiatrist

Strapping

Strapping helps to support the foot and reduce the strain on the plantar fascia.

Orthoses

Special inserts that fit in your shoes will be prescribed if there is an underlying structural abnormality causing the plantar fasciitis.

Night splint

A night splint will maintain the stretch on the plantar fascia whilst sleeping and usually helps to reduce the morning pain

Extracorporeal Shockwave Therapy

For those patients whose condition has not improved with any previous treatment, high energy sound waves can be used to break down scar tissue and increase blood flow. However, this treatment is not suitable for everyone and is painful.

Steroid injection

A steroid injection may reduce the pain. Your doctor might do this or your podiatrist can refer you to Podiatric Surgery.

Surgery

A small percentage of people may need surgery if all conservative treatments fail.