What is plantar fasciitis?

Plantar fasciitis is a common condition that causes pain in the underside of the heel. It is also known as 'jogger's heel', as it is often aggravated by exercise, such as jogging.

Causes

The plantar fascia is a band of connective tissue that runs between the heel and the ball of the foot. In plantar fasciitis, this band of tissue becomes irritated, particularly at the point where it attaches to the heel. 

There is recent evidence that suggests plantar fasciitis is caused by degeneration of the fascia. Small tears weaken the band of tissue and cause the pain of plantar fasciitis. This is often age-related, but can also occur in younger people as a result of repetitive strain and/or excessive stretching. 

Triggers for plantar fasciitis include:   

  • Flat feet;
  • High arching feet;
  • Excessive running;
  • Prolonged standing or walking occupations;
  • Obesity, and;
  • Tightness in the calf or foot muscles.

Heel pain; anatomy of plantar fasciitis; foot pain.An irritated plantar fascia causes pain in the heel. 

Risk factors

Risk factors for plantar fasciitis include:

  • Age - being over 40 years of age;
  • Gender - it is more common in women, and;
  • Prolonged standing.

Signs and symptoms

Symptoms of plantar fasciitis include the following:     

  • Pain under the heel of the foot, which can radiate towards the sole;
  • Pain that is usually worse first thing in the morning or after a period of rest;
  • Usually one side of the foot hurts more than the other;
  • Pain when wearing different types of footwear, and;
  • Tenderness often felt underneath the heel, often made worse by pressing on the fascia.

Methods for diagnosis

A diagnosis can often be made based upon the symptoms and by performing a physical examination of the heel. Imaging tests, such as a X-ray or ultrasound, are rarely used for diagnosis, but can be used to exclude other causes of heel pain.

Ultrasound

A scan that uses high-frequency soundwaves to produce images of the body’s internal structures.

X-ray

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

Types of treatment

Self care

Resting the heel is important, so limiting activities that aggravate the symptoms is advised. This may include running or walking shortened distances, or even stopping those activities completely in the short-term. An icepack applied to the heel can also be useful in reducing acute pain.

Pain-relief medications

The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also help reduce pain in the short-term, especially when combined with other treatments.

Physical therapies 

Stretching of the plantar fascia and muscles of the foot and calf are useful when pain does not settle with rest and pain-relief medications. There are several ways of stretching the areas involved and these can be taught by a doctor or physiotherapist. Deep tissue massage can also be helpful in reducing acute pain in some people.

Heel stretch exercises; treatment for heel pain; physical therapy for plantar fasciitis.Stretching exercises to relieve symptoms of plantar fasciitis. 

Foot orthotics

Foot orthotics are often used to help ease the pain of plantar fasciitis. Orthotics are devices that are inserted into the shoe, which take the pressure of the plantar fascia, usually by raising the heel and enabling the calf to relax. The simplest type of orthotic is called a heel raiser, which is a rubber pad inserted into the heel of the shoe. More complex orthotics involve the whole foot and have to fit completely within the shoe. A person may need to see a podiatrist to have these assessed properly. Further options include night splints, which are specially designed devices worn at night to help prevent the foot from abnormal postures overnight. These can be uncomfortable and as such their use is limited to those suffering from chronic pain. Sometimes a person can be taught ways to tape their foot in order to better support it, but this method is only designed for short-term use as it provides minimal help to resolve the issue. 

Injections

For severe swelling and pain, an injection of local anaesthetic and corticosteroid may be given into the tender area. In most cases, this works quickly to reduce symptoms. These injections are generally limited to only a few times a year, to avoid side effects such as muscle wasting or localised skin discolouration.

Treatment options for persistent pain

If the above measures have not helped resolve the symptoms of plantar fasciitis after six months, then ultrasound therapy or surgery may be tried. Ultrasound therapy, or extracorporeal shock wave therapy, uses soundwaves to improve blood flow and aid in healing the degenerated plantar fascia. The beneficial results for this treatment are varied. Surgery, known as plantar fasciotomy, is a procedure whereby a small part of the fascia is removed, which helps relieve tension on the fascia and reduces the pain.

Corticosteroid

A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.

NSAIDs

Non-steroidal anti-inflammatory drugs are commonly used to manage arthritis-related pain and inflammation and other musculoskeletal disorders. NSAIDs include aspirin and ibuprofen.

Physiotherapist

A healthcare professional trained in treating injury or disability with physical remedies, such as massage or exercise.

Ultrasound

A scan that uses high-frequency soundwaves to produce images of the body’s internal structures.

Prognosis

The outlook for plantar fasciitis is generally good, as it tends to heal within a year, without treatment. The above treatment options can resolve the condition much sooner.

Prevention

A person can help to prevent plantar fasciitis by:

  • Allowing enough time to rest the heel, especially if there is pain;
  • Avoiding long periods on their feet, not walking barefoot, or exercising on hard surfaces, and;
  • Always stretching, especially first thing in the morning.