Plantar FasciitisPlantar Fasciitis

The plantar fascia is a flat ligament type tissue made up of three bands that travel from the heel bone under the arch to just in front of the ball of the foot. Like other ligaments, it does not stretch but is designed to maintain the curvature of the arch of our feet and provide stability to our foot as we step off. While it is incredibly strong,  we regularly see people complaining of pain in the heel because of injury to the plantar fascia. The most common reason is where small tears have developed in the plantar fascia, which have become inflamed: this condition is usually called plantar fasciitis, (the 'itis' at the in meaning inflammation). While it is normally a overuse condition and may develop gradually, multiple small injuries to the plantar fascia, (for which the person is unaware of), can be exacerbated and further injured by a single episode of high-pressure, (e.g. walking around town all day in the wrong shoes or standing on a ladder or jumping out of a truck.)

Factors that will increase your risk of having Plantar Fasciitis

  1. Tight calf muscles
  2. Moderate to marked lower leg and foot biomechanical misalignments
  3. Poor functioning joints in the midfoot and especially the big toe joint,  leading a condition called functional hallux limitus (Fhl)
  4. Lifestyle stresses: e.g. new sport that is placing higher stress on the foot
  5. Poor Footwear choices

The symptoms you can feel

The most common presenting symptom with plantar fasciitis is in severe pain first thing out of bed in the morning or taking the first few steps after sitting for long period of time. This can be due to many reasons, but often it is due to the connect tissue linkage between the plantar fasciitis and (tight) calf muscles. Most people, as they sleep in bed, position themselves in a fetal position, (curled up on their side, with feet pointing down). This allows the calf muscles to tighten up, so when you get out of bed and stand up, the calf muscle is not able to stretch out immediately. This causes the foot to compensate usually by rolling in, resulting in huge stress being placed on the plantar fascia. After some time of walking around or after a hot shower, the calf muscle stretches out, relieving the pressure on the plantar fascia and so the symptoms improve.

Is this you? Try this simple exercise to see if it helps:

  • Before getting out of bed, while still under the warm bedclothes, gently prepare the calf muscle by bringing your toes towards your leg, but gently now!
  • Repeat this 20 times, slightly increasing on the 6th, 11th and 16th time
  • This will help the calf muscle get ready to function and increase the blood supply to the area and help lubricate the joints of the foot

We hope this helps!

Less common symptoms can be burning, tearing, aching that can become very sharp and a bruising feeling under the heel.

Treating this condition

The most difficult part of a successful treatment of plantar fasciitis is the correct diagnosis of what is causing the pain. The reason why there is so many treatments available for heel pain is that it does vary from person to person and it can be caused by a number of reasons. SO there is no one treatment that solves every plantarfascitis condition: no matter what the ads say!

My first advice would be to save you money and consult a podiatrist who regularly sees and treats heel pain. Once a thorough examination has done you may be offered the following treatment options:

  • rest: no sport, lessening activities requiring walking up and down stairs, no standing on ladders, wearing shoes with a small heel, lessening your day-to-day activities
  • direct resting of the injury: rigid sports taping (this can also be used to see if the pain is mechanical in nature), CAM Walker boots, plaster casts
  • mobilisation and manipulation of the joints of the ankle and foot: these may be 'out of place' and so not working properly. This can place high pressures on the plantar fascia as we walk, run and even with prolonged periods of holding the foot in the same position, such as when you are driving your car
  • ice massage: either through direct massaging with ice or rolling your foot over a bottle filled with frozen water for 10 minutes twice daily. To do this fill a plastic soft drink bottle, (ones with waists are the best) with water to three-quarter full and then freeze overnight
  • stretching: stretching the plantarfascia and calf muscles to improve their flexibility is a great way to reduce the pressure off the plantarfascia,
  • Improving the function of the foot: correctly prescribed orthotics can significantly improve the pain you feel, how your foot works and reduce the risk of that occurring again
  • anti-inflammatory tablets and cortisone injections: anti-inflammatory tablets are a powerful means to reduce the pain you feel because of the injury and inflammation. While many people are scared to take tablets, often over a very short period of time it is a good idea as it will stop you walking away from the pain which can sometimes lead to inflammation of other parts of the leg and feet, so long as you are actively addressing the issue that caused the plantar fasciitis in the first place. A cortisone injection is one of the most powerful anti-inflammatory measures we have wear a single injection can give up to three months pain relief. It has to be noted however, that this is not addressing the issues rather giving you relief from the pain, so the other areas still need to be addressed
  • other options include: acupuncture, night splints, surgery, Extracorporeal shock wave therapy, or ESWT, huge number of ' guaranteed successful' treatments of the Internet

WARNING: This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.