Plantar fasciitis is a painful condition affecting the connective tissue that stretches between the heel and the middle of the foot. It is usually caused by overuse, injury or muscular abnormalities. In extracorporeal shockwave therapy, a machine is used to deliver sound waves to the painful area. It is not known exactly how it works, but it is thought that it might stimulate healing of the fascia.
This is a problem of either extreme, so people with high arches or those that have very flat feet are at risk of developing pain in this region. This is because of the relative stress the plantar fascia is put under. In people with excessive pronation, the plantar fascia is put under too much stretch, as their range flattens and strains it. People with a stiff, supinated (high-arched) foot lack the flexibility to appropriately shock absorb, so this too puts extra strain on the plantar fascia. Clinically, we see more people presenting with plantar fascia pain who have excessive pronation than those with stiff, supinated feet. But while the foot type is the biggest risk factor for plantar fasciitis, the whole leg from the pelvis down can affect how the foot hits the ground. A thorough biomechanical assessment will determine where in the kinetic chain things have gone wrong to cause the overload.
Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ‘First step’ pain (stone bruise sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.
If you see a doctor for heel pain, he or she will first ask questions about where you feel the pain. If plantar fasciitis is suspected, the doctor will ask about what activities you’ve been doing that might be putting you at risk. The doctor will also examine your foot by pressing on it or asking you to flex it to see if that makes the pain worse. If something else might be causing the pain, like a heel spur or a bone fracture, the doctor may order an X-ray to take a look at the bones of your feet. In rare cases, if heel pain doesn’t respond to regular treatments, the doctor also might order an MRI scan of your foot. The good news about plantar fasciitis is that it usually goes away after a few months if you do a few simple things like stretching exercises and cutting back on activities that might have caused the problem. Taking over-the-counter medicines can help with pain. It’s rare that people need surgery for plantar fasciitis. Doctors only do surgery as a last resort if nothing else eases the pain.
Non Surgical Treatment
Usually, the pain will ease in time. ‘Fascia’ tissue, like ‘ligament’ tissue, heals quite slowly. It may take several months or more to go. However, the following treatments may help to speed recovery. A combination of different treatments may help. Collectively, these initial treatments are known as ‘conservative’ treatments for plantar fasciitis. Rest your foot. This should be done as much as possible. Avoid running, excess walking or standing, and undue stretching of your sole. Gentle walking and exercises described below are fine. Footwear. Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support. A laced sports shoe rather than an open sandal is probably best. Avoid old or worn shoes that may not give a good cushion to your heel. Heel pads and arch supports. You can buy various pads and shoe inserts to cushion the heel and support the arch of your foot. These work best if you put them in your shoes at all times. The aim is to raise your heel by about 1 cm. If your heel is tender, cut a small hole in the heel pad at the site of the tender spot. This means that the tender part of your heel will not touch anything inside your shoe. Place the inserts/pads in both shoes, even if you only have pain in one foot. Pain relief. Painkillers such as paracetamol will often ease the pain. Sometimes anti-inflammatory medicines such as ibuprofen are useful. These are painkillers but also reduce inflammation and may work better than ordinary painkillers. Some people find that rubbing a cream or gel that contains an anti-inflammatory medicine on to their heel is helpful. An ice pack (such as a bag of frozen peas wrapped in a tea towel) held to your foot for 15-20 minutes may also help to relieve pain. Exercises. Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. This is because most people with plantar fasciitis have a slight tightness of their Achilles tendon. If this is the case, it tends to pull at the back of your heel and has a knock-on effect of keeping your plantar fascia tight. Also, when you are asleep overnight, your plantar fascia tends to tighten up (which is why it is usually most painful first thing in the morning). The aim of these exercises is to loosen up the tendons and fascia gently above and below your heel. Your doctor may refer you to a physiotherapist for exercise guidance.
More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.
Exercises designed to stretch both your calf muscles and your plantar fascia (the band of tissue that runs under the sole of your foot) should help relieve pain and improve flexibility in the affected foot. A number of stretching exercises are described below. It’s usually recommended that you do the exercises on both legs, even if only one of your heels is affected by pain. This will improve your balance and stability, and help relieve heel pain. Towel stretches. Keep a long towel beside your bed. Before you get out of bed in the morning, loop the towel around your foot and use it to pull your toes towards your body, while keeping your knee straight. Repeat three times on each foot. Wall stretches. Place both hands on a wall at shoulder height, with one of your feet in front of the other. The front foot should be about 30cm (12 inches) away from the wall. With your front knee bent and your back leg straight, lean towards the wall until you feel a tightening in the calf muscles of your back leg. Then relax. Repeat this exercise 10 times before switching legs and repeating the cycle. You should practise wall stretches twice a day. Stair stretches. Stand on a step of your stairs facing upstairs, using your banister for support. Your feet should be slightly apart, with your heels hanging off the back of the step. Lower your heels until you feel a tightening in your calves. Hold this position for about 40 seconds, before raising your heels back to the starting position. Repeat this procedure six times, at least twice a day. Chair stretches. Sit on a chair, with your knees bent at right angles. Turn your feet sideways so your heels are touching and your toes are pointing in opposite directions. Lift the toes of the affected foot upwards, while keeping the heel firmly on the floor. You should feel your calf muscles and Achilles tendon (the band of tissue that connects your heel bone to your calf muscle) tighten. Hold this position for several seconds and then relax. Repeat this procedure 10 times, five to six times a day. Dynamic stretches. While seated, roll the arch of your foot (the curved bottom part of the foot between your toes and heel) over a round object, such as a rolling pin, tennis ball or drinks can. Some people find that using a chilled can from their fridge has the added benefit of helping to relieve pain. Move your foot and ankle in all directions over the object for several minutes. Repeat the exercise twice a day.