INTRODUCTION
Plantar Fasciitis is a common condition affecting up to 10% of the population. It can affect both active and sedentary adults of all ages. However it is more likely to occur in overweight individuals or those who spend all day on their feet. Plantar Fasciitis can be caused either by an acute injury or from cumulative overuse stress to the plantar fascia.
DIAGNOSIS
Patients often describe a throbbing, piercing or stabbing pain on the sole of their foot when they walk which is worse first thing in the morning. This pain often improves after a few steps but may worsen with prolonged activity or when walking barefoot. Examination often reveal exquisite tenderness over the inside part of the heel.
INVESTIGATIONS
An X-Ray may show heel spurs but this is not diagnostic as 20% of people without plantar fasciitis have heel spurs anyway. Ultrasound may show a thickened or torn plantar fascia or exclude another possible diagnosis other than plantar fasciitis.
PROGNOSIS
Although plantar fasciitis is a self-limiting condition, recovery is often slow with one study reporting that 80% of patients were pain free within 4 years.
TREATMENT
There are many treatment options for plantar fasciitis ranging from pain relief to attempts at healing depending on the acuity and severity of the condition.
Pain Relief
- Ice – useful for acute pain
- Medications – Paracetamol and non-steroidal anti-inflammatory (e.g. Ibuprofen)
- Gel heel cups – these can be placed in the shoe and provide support
- Massage – rolling an iced water bottle or rolling pin over the heel may provide relief
- Walker boot – this is useful for very acute pain or if there is a torn plantar fascia
Stretching
The plantar fascia is connected to the Achilles tendon around the heel. Stretching the calf muscles can unload the tension on the injured plantar fascia. Stretches are particularly useful first thing in the morning when the pain is at its worst. The Strassburg sock, a specialised type of sock that keeps your foot at 90 degrees to your leg, may be worn at night to help stretch the calf and plantar fascia.
Exercises
Living in Western Society means we lose the intrinsic strength of our feet due to our reliance on footwear. Toe strengthening exercises strengthen the intrinsic muscles of our feet and can unload the strain on the plantar fascia.
Activity Modification
Patients with plantar fasciitis may have to reduce or even completely cease the aggravating activity to adequately rest the plantar fascia. In the meantime, other non-impact activities such as cycling, swimming or use of the aerobic cross trainer may be undertaken to maintain cardiovascular fitness.
Biomechanics
A flat foot, high arches or feet that roll in excessively may worsen plantar fasciitis. It may be worth considering a pair of insoles or orthotics to help correct any abnormal foot biomechanics and to lift the rear foot to unload the plantar fascia.
Injections and beyond …
A cortisone injection may provide short to medium term relief. Autologous blood and PRP injections are being more frequently used in the treatment of plantar fasciitis. This involves the injection of the patient’s own blood into the plantar fascia. A small percentage of patients may require surgery for chronic and severe intractable pain.