Plantar fasciitis, also know as Plantar fasciopathy or Plantar fascia pain refers to a tenderness usually at the origin of the Plantar fascia on the bottom of the foot at the base of the heel or arch. The Plantar fascia is the band of tissue that runs from your heel to your toes. It supports the arch of your foot and provides shock absorption.
Symptoms of Plantar Fasciitis
You may have plantar fasciitis if you have:
- Pain around the heel of the foot when trying to take your first few steps in the morning when getting out of bed or after sitting for a while.
- Pain in the heel the longer you are on your feet.
- Heel pain that may ease with exercise, but then is much worse after cooling down.
- Heel or arch pain with standing up onto your toes.
- Pain walking in bare feet on hard surfaces which is eased with cushioning footwear
Causes of Plantar Fasciitis
Like many other tendon conditions, it most often occurs due to repetitive cumulative micro trauma. As the force absorbing capacity of the plantar fascia is exceeded during weight bearing activities like walking or running, the tissue breaks down and with cumulative trauma, it fails to repair before it is injured again.
The following factors increase your risk of developing this injury:
- Flat foot or high arch
- Overpronation of foot (rolling in of the foot)
- Tight calf muscles
- Poor biomechanics, which may be due to muscle weakness around hips
- Being overweight
- Wearing hard based shoes and spending a lot of time on your feet
The Plantar fascia is a band of fibrous tissue that runs from the heel bone to the toes. It maintains the arch of the foot and helps absorb load during the gait cycle. It has a thick attachment point onto the heel bone and it is at this origin or adjacent to it, where most of the issues arise.
How to diagnose
Assessment usually involves a series of questions to work out what might be contributing to your symptoms. The Physiotherapist will look at your biomechanics and flexibility so see what may need correcting to offload the Plantar fascia. We may perform an Ultrasound scan which will visualise the Plantar fascia to see if there is any tears or thickening to the tissue indicating trauma and damage.
The mainstay of treatment is to remove the aggravating factors that have caused the issue in the first place. This may be with:
- Footwear modification to more support and cushioning
- Stretching and massage to the calf muscles
- Strengthening of the calf and ankle muscles. The Plantar fascia is an extension of the achilles tendon which is the calf muscles connection to the heel bone. Improving calf strength will improve the Plantar fascia strength.
What you can do to help?
- Self-massage under your foot with a frozen bottle
- Avoid aggravating activities
- Avoid walking barefoot and wear well cushioned / supportive shoes, a silicon gel heel pad may help.
- Regularly stretch the plantar fascia, gastrocnemius and soleus –
Shockwave treatment for Plantar Fasciitis is designed to be “pro-inflammatory”. This means we are trying to get the body into a state where it can self-heal the damaged tissue.
This is done may using an acoustic pressure wave to create tissue damage at the origin of the Plantar fascia. We use EMS Dolorcast Radial Shockwave machines to treat this condition if it is failing to respond to Physiotherapy treatment and it works very well.
The National Institute of Care and Excellence (NICE) who govern the NHS, recommend a minimum of 3 session of shockwave in the treatment of this condition. The downside is that treatment is painful and will require a period of rest for 24-48 hours after each treatment. Rest involves doing your normal activities but no exercise on the legs to avoid aggravating things further. You should also not take any anti-inflammatory medication while you are receiving shockwave treatment so you will be limited to paracetamol only if required. You can read more about shockwave treatment here:
Ultrasound-guided Steroid injection
Ultrasound-guided steroid injections are a last resort in the treatment of Plantar fasciitis. The location of the steroid injection is important to ensure we do not cause any damage to the surrounding fat pad in the heel of the foot. It can be a painful injection, so we may offer to perform a nerve block to the heel first which will make the procedure much more tolerable.
For the right patient, this treatment will work well but does not address the underlying cause of the condition. Therefore it is important we still focus on strengthening and footwear modification. We may also ask you to wear a walker boot after this procedure to support and offload the Plantar fascia while the medication takes effect.
If you are experiencing symptoms similar to those described above and want to find out what is causing your pain, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 0207 636 5774 or email email@example.com