FOOT & ANKLE

Plantar Fasciitis

The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot and supports the arch of your foot. Plantar fasciitis is one of the most common causes of bottom heel pain and occurs when the plantar fascia becomes irritated and inflamed.


Find out more about Heel Pain.

Symptoms

The most common symptoms of plantar fasciitis include:

  • Pain on the bottom foot near the heel
  • Pain with the first steps getting out of bed in the morning or after long periods of rest 
  • Greater pain after exercise or activity



Causes

The plantar fascia functions as a shock absorber and supports the arch of your foot. Excessive pressure over the fascia may strain and tear the tissue causing heel pain. Repeated overstretching or overuse causes irritation or inflammation of the fascia. 

 

Other risk factors may include obesity, foot arch problems such as flat feet or high arches, repetitive high impact activity (long-distance running, dance, sports), occupations that necessitate walking or standing on hard surfaces for a long period, wearing shoes with poor arch support or thin-soled shoes, obesity and tight calf muscles.



Diagnosis

Diagnosis is made by medical consultation, taking the patient's past medical history and examination of the foot to check for signs of flat feet or high arches, tenderness, swelling, redness and stiffness or tightness of your foot arch. X-ray or MRI scan may also be requested to rule out after causes of heel pain such as stress fracture or pinched nerve.



Treatment Options

Non Operative Treatment

Most patients with plantar fasciitis can be treated effectively non operatively with the following measure:

  • Rest - decrease or avoid activities that worsen pain
  • Ice - over the affected area at least twice a day for 10-15 minutes for the first few days to relieve pain
  • Stretching - your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
  • Night splints - to stretch the plantar fascia and allow it to heal
  • Supportive Shoes and Orthotics - shoes with good support and cushioning. Custom orthotics (shoe inserts) may also be helpful. 
  • Physiotherapy - Your physical therapist may design an exercise program that focuses on stretching your plantar fascia and Achilles tendon, and strengthening the muscles of the lower leg.
  • Taping - to support the foot (physiotherapist can do this)
  • Pain medication (paracetomol or panadol osteo) and anti-inflammatories - if tolerated and not contraindicated
  • Injections - such as cortisone to help relieve pain
  • Extracorporeal shockwave therapy (EST) - where high-energy sound waves are target to the painful area to stimulate the healing process


Surgery

Surgery is rarely needed, but is an option for patients who do not respond adequately to at least 6 to 12 months of adequate non operative treatment. Surgery may involve a partial plantar fascia release to relieve tension in the tissue and/or gastrocnemius recession to lengthen the calf (gastrocnemius) muscle.

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