Plantar fasciitis is a common condition that causes heel pain. It occurs when the plantar fascia, a thick band of tissue that runs along the bottom of the foot from the heel to the toes, becomes inflamed or irritated.
Causes of heel pain
Plantar fasciitis can be caused by several factors, including:
Overuse or repetitive strain on the feet, such as from running or standing for long periods of time.
Flat feet or high arches, which can put additional stress on the plantar fascia.
Being overweight or obese, which can increase the load on the feet and cause more strain on the plantar fascia.
Wearing shoes with poor arch support or that are worn out.
Tight calf muscles or Achilles tendon, which can put additional stress on the plantar fascia.
Symptoms of heel pain
Symptoms of plantar fasciitis include sharp pain or aching in the heel or arch of the foot, especially when taking the first few steps after waking up in the morning or after a period of inactivity. The pain may improve with activity but may worsen with prolonged standing or walking.
Pain is usually well localised to the under-surface of the heel but may radiate into the arch. It is typically worse when first arising from bed and after long periods sitting. This is because the plantar fascia shortens or tightens up when the foot is not bearing weight over a long period of time. Pain is also worsened by standing for long periods, walking on hard surfaces, or wearing shoes with little cushioning. If left untreated, the condition often lasts six months or more and in some patients it continues indefinitely.
Diagnosing plantar fasciitis
Diagnosing plantar fasciitis typically involves a thorough medical history and physical examination. Dr Singh will ask you about your symptoms, including the location, duration, and intensity of the pain. He may also ask about your daily activities, occupation, exercise routine, and footwear.
During the physical examination, Dr Singh may perform a variety of tests to assess your foot and ankle mobility, as well as the presence of any tenderness or swelling in the affected area. He may also ask you to stand or walk in order to assess your gait and foot mechanics.
In some cases, imaging tests such as X-rays or MRI scans may be ordered to help confirm the diagnosis or rule out other conditions such as a stress fracture or a ruptured tendon.
Treatment for heel pain
Treatment for plantar fasciitis typically involves rest, ice, stretching exercises, and wearing shoes with good arch support. Anti-inflammatory medication may also be helpful to reduce pain and inflammation. In severe cases, immobilisation in a boot or cast may be necessary to allow the plantar fascia to heal. Dr Singh may also recommend Physical therapy and orthotics may also be recommended to address underlying foot mechanics that may be contributing to the condition.
The most important component of treatment is regular stretching exercises. The stretches are designed to stretch the gastrocnemius (calf) muscle, the plantar fascia, and the Achilles tendon. Each stretch needs to be held for 20 seconds and repeated ten times. Doing all three stretches should take about ten minutes and must be done three times a day – this is critical.
The gastrocnemius (calf) stretch is performed by standing against a solid wall with the painful foot (right foot in this picture) behind you. Point the toes of this foot inwards towards the heel of the front foot. Keep the knee of the painful foot straight and bend the front knee forward – you should feel the calf muscle becoming tight.
The Plantar fascia stretch is done by wearing a shoe with a flexible sole and jamming the shoe (right foot in this picture) into the junction between the wall and the floor. Bend the front knee forward and you will feel the sole of the foot and the Achilles tendon being stretched.
Lastly the Achilles tendon is easily stretched by hanging both heels over a step and letting the heels gently drop. You should feel the stretch in the Achilles and the sole of the foot.
In rare cases, surgery may be necessary. The reason for restricting surgery is that it is not always effective. Approximately 70-80% have a significant improvement with surgery but this leaves a large proportion who are no better. A small number of patients are in fact made worse by surgery, and this is essentially untreatable.
The most common surgical procedure for plantar fasciitis is called a plantar fascia release. This procedure involves partially cutting the plantar fascia to relieve tension and pressure on the affected area, allowing the tissue to heal and regenerate. Surgery involves dividing half of the plantar fascia to reduce its tension. This can be done by an open (most commonly) or an endoscopic (keyhole) procedure. The main risk is failure of improvement as describes earlier but infection and wound healing problems are also a remote possibility.
This will all be discussed with you in consultation with Dr Singh.
