Common Conditions We Treat

What causes Plantar Fasciitis?

Repeated small injuries to the fascia (with or without inflammation) are thought to be the primary cause of plantar fasciitis. The damage is usually near where the plantar fascia attaches to your heel bone.

You are more likely to injure your plantar fascia in certain situations

For example:

• If you spend excessive amounts of time standing and being on your feet or walking. (The condition is sometimes called 'policeman's heel', as policemen 'walking the beat' were said to be commonly affected).
• If you increase your activity levels too early and your body is not used to the amount of exercise you are now undertaking
• Also, people with a sedentary lifestyle are more prone to plantar fasciitis.
• If you have recently started exercising on a different surface. For example, running on the road instead of a track.
• If you have been wearing shoes with poor cushioning or poor arch support.
• If you are overweight, this will put extra strain on your heel.
• If there is overuse or sudden stretching of your sole. For example, athletes who increase running intensity or distance, have poor technique starting 'off the blocks.
• If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Often there is no apparent cause for plantar fasciitis, particularly in older people.

How common is plantar fasciitis?

Plantar fasciitis is common. Around 1 in 10 people will get plantar fasciitis at some time in their life. It is most common in people between the ages of 40 to 60 years. However, it can occur at any age. It is twice as common in women than men. It is also common in athletes.

What are the symptoms of plantar fasciitis?

Pain is the main symptom. This can be anywhere on the underside of your heel. However, one spot is commonly found as the primary source of pain. This is often about four centimetres forward from your heel and may be tender to touch.

The pain is often worst when you take your first steps on getting up in the morning or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often worsens the pain. Resting your foot usually eases the pain. 

Sudden stretching of the sole of your foot may make the pain worse. For example, walking upstairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.

How is plantar fasciitis diagnosed?

At Footfix, our Podiatric team can usually diagnose plantar fasciitis just by talking to you and examining your feet.

Tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include weight-bearing X-rays of the heel, and diagnostic and ultrasound tests, which are both provided in our clinics.

What is the initial treatment for plantar fasciitis?

A combination of different treatments may help. Collectively, these initial treatments are known as 'conservative' treatments for plantar fasciitis; these are things you can do easily without having to come to see a podiatrist.

Conservative Treatments

Rest your foot

This should be done as much as possible. Avoid running, excess walking or standing, and undue stretching of your sole. Gentle walking and exercises described below are fine.

Footwear

Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and good arch support. A laced sports shoe, for example, will be much better than open-toed sandals. Avoid old or worn shoes that may not give a good cushion to your heel.

Pain relief

Painkillers such as paracetamol will often ease the pain. Sometimes anti-inflammatory medicines such as ibuprofen are helpful to ease the painful symptoms. These painkillers also reduce inflammation and may work better than ordinary painkillers. 

Some people find that rubbing a cream or gel containing an anti-inflammatory medicine on their heel helpful. We recommend multiple products; either Biofreeze or Traumel Gel are the best options. Take a look at some of the products we offer to provide heel pain relief. 

Alternatively, you can apply an ice pack to your foot. You should try to hold the cold compress on your foot for around 20 minutes to relieve the pain.  

Exercises

Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. You could also use a passive device called a dorsal night splint. These can be effective in stretching your plantar fascia while you sleep. This is because most people with plantar fasciitis have a slight tightness of their Achilles tendon. If this is the case, it tends to pull at the back of your heel and keeps your plantar fascia tight. Also, when you are asleep overnight, your plantar fascia tends to tighten up (which is why it is usually most painful first thing in the morning). These exercises aim to gently loosen the tendons and fascia above and below your heel.

Are there any other treatments?

If the above treatments are not helping to relieve your symptoms, or if you are someone such as an athlete who needs a quick recovery, other treatments are available. There is no one specific treatment that appears to stand out as the best. 

Massage and Manipulations

At Footfix, we can provide a functional assessment of muscles and tendons. We may suggest that a course of deep muscle and tendon massage with joint manipulations may be suitable for your heal pain. We would require you to come in once a week for approximately four weeks to provide you with thorough and regular assessments.

Heel pads and arch suporting orthotics 

At Footfix, we use various pads and shoe inserts/insoles as the first line of treatment for plantar fasciitis. You can try some of the heel and arch support shoe inserts that we supply very quickly and efficiently to relieve plantar fasciitis symptoms. 

If you are still suffering the effects of plantar fasciitis after the treatment options mentioned above. It may be time to try custom-made orthotics to provide cushioning and support to the heel and arch of your foot. These are tailor-made to you and provide a much higher level of support than generic heel cups. These work best if you put them in your shoes at all times. The aim is to raise your heel by about 1 cm. If your heel is tender, a small hole in the heel pad at the site of the tender spot may help. This means that the delicate part of your heel will not touch anything inside your shoe. Place the inserts/pads in both shoes, even if you only have pain in one foot. We use Superfeet Insoles as a first-line treatment as they are easy and comparatively cheaper when compared to bespoke orthotics. They come in different colours, which are a guide to the contour of your foot.

Steroid injections

A steroid (cortisone) injection is sometimes tried if your pain remains bad despite the above 'conservative' measures. It may relieve the pain in some people for several weeks but does not always cure the problem.

We always put the whole foot to sleep so we can inject the area without you having any pain.

Steroids work by reducing inflammation. Sometimes two or three injections are tried over a period of months if the first is not successful.

Steroid injections do carry some risks, including but rarely the rupture of the plantar fascia. 

Extracorporeal shock-wave therapy 

In extracorporeal shock-wave therapy, a machine delivers high-energy sound waves through your skin to the painful area on your foot. It is not known precisely how it works, but it is thought that it might stimulate the healing of your plantar fascia. You will need a minimum of 3 sessions of treatment.

This procedure is a safe alternative to injection. You should fully discuss the potential benefits and risks with your podiatrist before undertaking this treatment method. 

In studies, most people who have had extracorporeal shock-wave therapy have little in the way of problems. However, possible problems that can occur include pain during treatment, skin reddening, swelling of your foot or bruising.

Surgical treatments

This may be considered in complicated cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone and is called a plantar fascia release. It may also involve the removal of a heel spur on the calcaneum if one is present.

Surgery is not always successful. It can cause complications in some people, so it should be only considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.

If you require surgery we will refer you directly to our Consultant Foot and Ankle Surgeon for a private consultation.