What is plantar fasciitis and how is it treated?

Consultant Orthopaedic Surgeon Col Paul Parker from BMI The Priory Hospital shares his advice on this common source of heel pain, discussing causes, symptoms and how to treat it.

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1 in 10 people will suffer from heel pain at some point in their working lives1

If you’re on your feet all day, or perhaps your BMI (body mass index) is a little higher than it ought to be, you may be one of these people.

Heel pain is often particularly bad in the morning when you take your first steps; you may even feel a tearing sensation. You’ll probably have some relief after this but then develop a dull ache that worsens over the day. Sound familiar?

If you’re wondering what’s to blame, it may be that you have a common foot condition called plantar fasciitis.2

What causes plantar fasciitis?

Plantar fasciitis happens when you strain the part of your foot that connects your heel bone to your toes. This is called the plantar fascia.

What does the plantar fascia do?

Today we may have expensive running shoes, but once we only had our feet to absorb the shock. I’m talking a very long time ago, when we had to run and hunt for food, perhaps alongside woolly mammoths.

Our feet are therefore designed to absorb repeated shocks. The mobile and flexible arches of our feet (one lengthways - the longitudinal arch or instep, and one crossways under our toe bases – the transverse arch) provide that shock absorption.

What holds these arches up? Well, the shape of the bones is one. In cross-section, your foot is like the keystones of a humpback bridge – only more flexible and with a guy-rope or bowstring at the bottom of the bridge holding the base together.3

This is the plantar fascia, which arises narrowly from your heel bone and inserts broadly into the front of your foot.4

It’s not always clear why people develop plantar fasciitis, though you might get it if you:

  • Have recently started exercising on hard surfaces
  • Exercise with a tight calf or heel
  • Overstretch the sole of your foot while exercising
  • Have increased the amount you walk, run or stand up
  • Are wearing non-supportive shoes
  • Have a high BMI5
Why is plantar fasciitis so common?

Although our feet are designed to absorb stresses and strains, it’s still possible to overstress the plantar fascia. This can mean the narrow origin at your heel is strained or even partially torn, causing much pain and discomfort.

When you go to bed at night, your body tries to heal this tear with scar tissue. That scar may contract too much because your foot flexes down when you sleep. In the morning, when you stand for the first time, the scar tears.

This is what we call the ‘Heal, Contract, Tear, Inflamed, Heal’ cycle. To treat the fasciitis (which means the inflamed fascia) we need to break that cycle.4

How can I treat plantar fasciitis at home?

Most heel pain will get better by itself, but this can take a while. I advise my patients to try these at-home methods, which can speed up recovery.

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Stretching exercises

Stretching exercises are the best starting point and you can do them yourself at home.

Sit comfortably, cross the affected leg over your thigh, get a good grip on your toes and forefoot and pull up slowly yet firmly. Hold for ten seconds and release. Repeat this 5-10 times a few times a day, especially before you get out of bed in the morning.6

Insoles

Shoe inserts and insoles are your next step. You don’t need custom insoles. In fact, research shows that so-called ‘off the shelf’ orthotics are just as good, if not better than custom ones.7 A good pair could cost you just £7.

Over-the-counter relief

Judicious use of a non-steroidal anti-inflammatory gel is a good idea. Coating your heel with one last thing at night before sleep (do let it dry first!) is helpful.

Speak to your pharmacist for more information and advice on how to use these gels safely.3

What can be done for severe plantar fasciitis?

If the above measures don’t work then we need to get slightly more intrusive.

Wear support to bed

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If your foot flops down at night, your plantar fascia contracts. You can prevent this (and still sleep) using night splintage.

At the softer end of the scale, the so-called ‘Strassburg Sock’ has been shown to help.8

Formal night splints are more rigid but – because of this – hold your foot more firmly, at 90 degrees overnight. Six weeks' use is often required but this can be curative.9

Steroid injections

As we reach further up the ladder of intervention, a targeted steroid (anti-inflammatory) injection under x-ray or ultrasound guidance is next.

We use x-ray or ultrasound guidance because it helps us inject the right spot.10 Up to three injections may be necessary, but don’t worry, they aren’t that painful.

Shockwave therapy

Surgery for plantar fasciitis is not usually required. Shockwave therapy, known as lithotripsy, is a more popular treatment.

This delivers a series of focused shockwaves to the plantar fascial origin breaking down any calcification and helping to restore normal function.11

If you have heel pain that isn’t going away, speak to your GP or consultant. They’ll be able to advise you on the most appropriate treatment.

Shockwave therapy is available at BMI The Priory Hospital in Birmingham, starting at £100 for a 30-minute session.  

To find out more about shockwave therapy at BMI The Priory or any of our other hospitals around the UK, make an online enquiry or call us for free on 0808 101 0337.

Sources
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687890/
2https://www.hey.nhs.uk/patient-leaflet/plantar-fasciitis/
3https://www.arthritis.org/about-arthritis/where-it-hurts/foot-heel-and-toe-pain/foot-anatomy.php
4https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs
5https://www.nhs.uk/conditions/plantar-fasciitis/
6https://www.csp.org.uk/public-patient/rehabilitation-exercises/foot-pain
7https://www.bmj.com/company/newsroom/custom-made-foot-orthoses-appear-to-be-no-better-than-over-the-counter-insoles-or-other-treatments-to-stop-heel-pain/
8https://www.ncbi.nlm.nih.gov/pubmed/12194511
9https://www.researchgate.net/publication/270476110_Effectiveness_of_Tension_Night_Splints_in_Treating_Plantar_Fasciitis_A_Review
10https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044731/
11https://www.nice.org.uk/guidance/ipg311/resources/treating-chronic-plantar-fasciitis-using-shockwave-therapy-pdf-312696253

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