Plantar Fasciitis

Did You Know?

1 in 10 of us will suffer with plantar fasciitis during our lifetime.

What Is Plantar Fasciitis?

Plantar fasciitis is irritation and inflammation of the plantar fascia. This is a band of connective tissue that connects your heel to your toes. The “itis” in fasciitis is Latin for inflammation, however we believe the inflammatory phase of plantar fasciitis is relatively small. Therefore, we now tend to use plantar fasciopathy when referring to this condition as it includes both the inflammatory and non-inflammatory periods.

Anatomy

The plantar fascia is a band of connective tissue that attaches the heel to the toes. The fascia is extremely tough and forms a part of the support mechanism for the arch of the foot. The facia consists of three parts the medial, central & lateral branches.

The central aspect of the fascia attaches to the medial aspect of the heel bone (very common area of discomfort) and moves up the foot towards the toes where it separates into five parts near the head of the metatarsal bones, which then attach to the toes.

Symptoms

The most common area of discomfort with plantar fasciopathy is the towards the front of the underside of the heel. Pain can also effect any aspect of the plantar fascia. We refer to pain in around the heel as insertional plantar fasciopathy due to the irritation being where the fascia inserts on the heel. Pain in the other parts of the fascia is referred to a mid-portion plantar fasciopathy. Common symptoms include:

• Pain in the heel when getting out of bed or after periods of rest

• Increased discomfort in the arch/heel after periods of activity

• Dull ache in the bottom of the heel

• Discomfort in the arch of the foot

What Causes Plantar Fasciitis?

There are many possible causes for planar fascia pain, most however are usually linked to a change in something for example footwear or activity levels. Here are a list of the most common contributors to plantar fasciopathy:

• Sudden increase is activity

• Change of footwear – a good example of this is seasonal changes in footwear e.g. going from supportive winter boots to less supportive summer sandals

• Occupation – occupations that involve long periods of standing or walking

• Foot mechanics – certain foot types will lead to increased loading of the plantar fascia

• Age – There is a higher prevalence of plantar fasciitis in people between the ages of 40 and 60.

• Tight calf muscles – some evidence suggests that tight calf muscles can contribute to increased risk of plantar fasciopathy

How To Treat Plantar Fasciitis

Like with most injuries that are many factors to consider when treating plantar fasciopathy. My initial advice would be to book in one of our MSK podiatrists so that they can advise on the best course of treatment and get you back on your feet asap. When treating plantar fascia pain I tend to use the 3s’ approach:

Stimulate
Due to the poor blood supply within the fascia we tend to advise tissue stimulation, this can include using rollers or fascia balls, massage and hot/cold therapy. In certain cases we might look to use Shockwave Therapy which can be used effectively on cases that are older than 4 months old.

Strengthen
As connective tissue, you can’t actually strengthen the plantar fascia, however we will often look to strengthen the muscles that help support the foot. This can include intrinsic muscle exercises (muscles within the foot) and extrinsic muscle exercises (muscles that influence the foot from further up the leg e.g. gastrocnemius).

Support
Knowing that a large part of the plantar fascia’s job is to help support the foot, we should be looking to compliment the fascia’s job by helping to support it. Certain foot types can increase load on the plantar fascia so having orthoses (insoles) which address your specific foot type can help reduce load on the fascia and support the foot. Footwear is also very important to consider, making sure footwear is stable and adequate for the daily/sporting activities.

Other treatments can include:

Steroid Injections
In my opinion due to this being an invasive procedure you should only consider steroid injections as a last option. I would also advise that you should still carry on with the previous non invasive advice.