Plantar Fasciitis (Heel Pain) Information Leaflet

You are suffering from a condition called plantar fasciitis. This is inflammation of the plantar fascia, a soft tissue structure on the sole of your foot that runs from the heel to the toes and helps support your arch.

This condition affects 10% of the population and is the second most common referral to foot and ankle departments. Plantar fasciitis normally resolves within 10 months irrespective of treatment. It is classified as a chronic condition when symptoms persist past 6 months. A minority of chronic heel pain sufferers (estimated at 10%) develop persistent, often disabling symptoms that continue for more than a year.


Causes

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

  • Change or increase in activity
  • Biomechanical factors – feet which have a low arch or tendency to roll inwards/pronate
  • Prolonged use of flat or unsupportive footwear
  • Tight calf muscles
  • Obesity or recent weight gain – 1/3rd of sufferers are overweight
  • Sudden injury

Patients often complain of:

  • Pain and tenderness beneath the heel, which can radiate into the arch of the foot.
  • Stiffness and discomfort on rising in the morning or after sitting
  • A heel spur – the relevance of this is questionable as many asymptomatic patients have heel spurs when they are x-rayed.
  • Shoes with poor cushioning or a decrease in fatty padding beneath the heel area with increasing age
  • Standing for long periods or on hard surfaces
  • Can be associated with inflammatory conditions

Clinical Treatment

1. A steroid injection: Has a strong anti-inflammatory effect which helps reduce pain locally in your heel. Studies indicate that patients who have an injection have a better outcome compared with patients who do not have this treatment. Your heel may be more painful for the first few days after the injection – painkillers and ice can help reduce this discomfort. It maybe several days before you notice the benefits of the injection.


Home treatments

2. Ice: Freeze a round bottle of water and roll it under the foot from the heel to the toes. Apply for 10 minutes every evening. This will help by:

  • Reducing local inflammation
  • Massaging and stretching the plantar fascia.

3. Calf muscle stretches: Tight calf muscles place extra tension on the plantar fascia and cause the feet to roll inwards/pronate. Stretching the calf muscles can help relieve your symptoms. It is essential to perform this exercise twice a day. It will take approximately three months for you to become fully flexible, but you will need to continue stretching regularly to prevent a recurrence in your symptoms.


How to perform the calf stretch:

  • Stand on an inclined ramp or use a thick book e.g. The Yellow Pages
  • Perform the stretch with bare feet
  • Stand with your toes straight or pointing towards each other slightly
  • Knees must be straight
  • If you cannot stand up straight, lower the ramp or use a thinner book
  • Slowly increase the height of the ramp/book as you become more flexible
  • Hold the stretch for 2 – 5 minutes and perform a minimum of twice daily -– AM & PM
  • DON’T BOUNCE

4. Arch support insole/orthotic: Supports the arch of the foot, reducing the strain on the plantar fascia by controlling excessive pronation. We recommend: ‘Ortha-heel’ Regular Orthotics, which can be purchased from most high street chemists for around £25 a pair or off the internet at a cheaper price. These are ¾ length navy insoles with a structured arch (the &Lsquo;slim-fit’ style is not suitable). These should be worn on a daily basis in lace-up shoes for maximum effect. If your biomechanics or foot posture is considered to be the main cause of your plantar fasciitis, Miss Feeney may discuss a biomechanical assessment with you and custom-made orthotics.

5. Supportive lace – up footwear: Slip-on, unsupportive or flat shoes are a common cause of plantar fasciitis. Trainers or lace-up shoes should be worn during the treatment period, to help control excessive foot motion/pronation and allow orthotics to be used. A small heel can reduce the tension on the calf muscle and therefore help reduce symptoms.

6. Additional help:

  • We advise that you follow the treatment plan diligently or it is unlikely your symptoms will improve.
  • The majority of heel pain sufferers are overweight, so dieting will be beneficial. The less you weigh, the less stress the plantar fascia is under.
  • Acupuncture may be beneficial however; the hospital is unable to provide this service.
  • You can use the Google search engine to find the Cochrane library. This reviews the evidence base for medical and surgical treatments.
  • You can use anti-inflammatory gels or tablets if appropriate (please discuss with the clinician or your GP)

If progress is slow

7. Night Splint: This splint maintains the foot at 90 degrees to the ankle and prevents shortening of the calf muscles and plantar fascia during sleep. This can be provided when other treatments have failed.
8. Physiotherapy: In some cases physiotherapy utilising soft tissue mobilisation, taping to re-align the foot, stretches, ultrasound or laser therapy can be helpful.


Surgery

This treatment option is reserved for patients who do not respond to conservative care and continue to experience unremitting pain. Tension on the plantar fascia is released by cutting through it; patients walk in a plaster cast for four weeks after surgery. Published papers indicate that surgery may provide improvement in 48 to 86% of cases. However, research shows that patients can experience pain from other foot structures post-operatively.