Heel Pain - Plantar fasciitis

The plantar fascia is a band of thick tissue that runs along the sole of the foot. It runs from the heel bone (calcaneum) along the inside of the foot to the base of the toes. Its function is to help lift the arch of the foot when walking and act as a shock absorber for the whole leg.

What is Plantar Fasciitis?

Plantar fasciitis is a common condition that occurs when the plantar fascia becomes inflamed and irritated near where it attaches to the heel bone. Often there is a tenderness beneath the heel which can radiate into the arch of the foot.

This condition accounts for 11% to 15% of all foot symptoms referred to Foot and Ankle departments. Evidence suggests that 10% of the general population experience plantar fasciitis, with 83% of these patients being active working adults between the ages of 25 and 65 years old.

Plantar Fasciitis normally resolves within 10 months irrespective of treatment. It is classified as a chronic condition; when symptoms persist past 6 months.

What are the symptoms of Plantar Fasciitis?

Most common symptoms:

  • Stiffness – Stiffness and discomfort on rising in the morning or after sitting. This usually eases after a few minutes of walking. However, may last longer

  • Variable pain – Pain may settle during the day and with exercise, but is worse at the end of the day after periods of long standing or high levels of activity

  • Tenderness – Often beneath the heel bone, which can radiate into the arch of the foot

    Potential causes of Plantar Fasciitis

    The cause of plantar fasciitis remains unclear; however, a number of factors are known to be important:

  • Change or increase in activity levels

  • Biomechanical factors – feet which have a tendency to roll inwards/pronate

  • Prolonged use of flat or unsupportive footwear

  • Tight calf muscles

  • Obesity or recent weight gain – one third of those affected are overweight

  • trauma

  • Standing for long periods on hard surfaces, causing microtrauma.

  • Footwear with poor cushioning or a decrease in fatty padding beneath the heel area

  • It can be associated with inflammatory conditions – such as psoriatic arthritis,

 

Confirmation of the clinical diagnosis

Often imaging is not necessary to make a diagnosis of plantar fasciitis; Diagnosis can usually be made by the clinician using your medical history and clinical examination.

If however it is necessary to perform imaging, an Ultrasound scan is most likely to be performed. This will be complete by the Clinical Imaging department. Ultrasound scanning is a quick, safe and effective way to see the Plantar Fascia. The scan is performed using a handheld probe, which is rolled over the skin above the plantar fascia. An image is then created by the machine and can be seen.


X-ray may show a heel spur; a small piece of bone which grows on the underside of the heel bone. This can be mistaken for the cause of plantar fasciitis. Studies suggest about 50% of symptomatic patients and 20% of asymptomatic patients have heel spurs. However, many patients with plantar fasciitis have no heel spur.

What conservative treatments are available?

Available evidence does not suggest that any of the commonly used treatments for the management of plantar fasciitis are significantly better than any other. Studies state that a combination of treatment options are effective in reducing pain and improving function.

For full information on treatment options for plantar fascilitis and recovery, please see the attached PDF.