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Plantar Fasciitis

plantar fascitis

Plantar fasciitis means inflammation of your plantar fascia. Your plantar fascia is a strong band of tissue (like a ligament) that stretches from your heel to your middle foot bones. It supports the arch of your foot and also acts as a shock-absorber in your foot.

What causes plantar fasciitis?

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

You are more likely to injure your plantar fascia in certain situations. For example:

  1. If you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it.
  2. If you have recently started exercising on a different surface.
  3. If you have been wearing shoes with poor cushioning or poor arch support.
  4. If you are overweight, this will put extra strain on your heel.
  5. If there is overuse or sudden stretching of your sole.
  6. 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.
What are the symptoms of plantar fasciitis?

Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cms 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 makes the pain worse. Resting your foot usually eases the pain.

How is plantar fasciitis diagnosed?

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. X-rays of the heel or an ultrasound scan of the fascia can also be undertaken. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.

What is the initial treatment for plantar fasciitis?

Usually, the pain will ease in time. 'Fascia' tissue, like 'ligament' tissue, heals quite slowly. It may take several months or more to go.

  • Rest your foot
  • Footwear-Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support.
  • Heel pads and arch supports
  • Painkillers such as paracetamol will often ease the pain. Sometimes anti-inflammatory medicines such as ibuprofen are useful. An ice pack (such as a bag of frozen peas wrapped in a tea towel) and held to your foot for 15-20 minutes may also help to relieve pain.
  • Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. A qualified physiotherapist will be best able to assess the severity of your symptoms and advise the necessary exercises.
  • 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.
  • In extracorporeal shock-wave therapy, a machine is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works, but it is thought that it might stimulate healing of your plantar fascia. One or more sessions of treatment may be needed.
  • Other treatments include injection with botulinum toxin and treatment of the plantar fascia with radiotherapy. Some people benefit from wearing a special splint overnight to keep their Achilles tendon and plantar fascia slightly stretched.
Surgery

This may be considered in very difficult 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.

What is the prognosis for plantar fasciitis?

Most people have completely recovered from an episode of plantar fasciitis within a year. However, some of the treatments described above may help to speed up your recovery.


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