Solving the Mystery of Plantar Fasciitis – By Mr Martin Klinke

Plantar fasciitis is a prevalent and often debilitating condition that affects the bottom of the foot, primarily around the heel and arch of the foot.

As the leading cause of heel pain in the UK, plantar fasciitis impacts a wide demographic, from athletes to individuals with more sedentary lifestyles.

This article delves into the anatomy, causes, symptoms, risk factors, and treatment options for plantar fasciitis, giving some insight and helping those who are suffering from this condition to gain knowledge to be able to beat this common foot condition.

What is Plantar Fasciitis?

Plantar fasciitis is an overuse injury that occurs when the plantar fascia—a thick, fibrous band of tissue connecting the heel bone (calcaneus) to the toes—becomes irritated or inflamed. This tissue acts as a shock absorber, supporting the arch of the foot and playing a critical role in walking and running mechanics.

When excessive stress is placed on the plantar fascia, either due to a single event, or more usually, a low level of stress over a prolonged period of time, microtears can develop leading to inflammation, pain, and discomfort.

This condition typically develops gradually over a period of weeks or months, and is not always linked to a specific injury or trauma. Despite its prevalence, many sufferers delay seeking treatment, exacerbating the condition and prolonging recovery.

Anatomy of the Plantar Fascia

The plantar fascia is an important structural component of the foot, running from the heel bone to the base of the toes. It lies just beneath the skin on the sole of the foot and serves several vital functions:

• Arch Support: The plantar fascia provides stability to the foot's arches, ensuring efficient weight distribution during standing and walking.
• Shock Absorption: By stretching and contracting with each step, the plantar fascia absorbs impact forces, reducing stress on other foot structures.
• Propulsion: During walking and running, the plantar fascia aids in forward motion by storing and releasing energy.

Due to its constant involvement in movement and weight-bearing activities, the plantar fascia is highly susceptible to injury.

Causes of Plantar Fasciitis

Plantar fasciitis is a multifactorial condition with no single definitive cause. However, several contributing factors can increase your susceptibility to developing it.

1. Overuse or Overloading

• Repetitive Impact: Activities such as running, dancing, or jumping place repetitive stress on the plantar fascia.
• Prolonged Standing: Occupations requiring extended periods of standing (e.g., teachers, healthcare workers) can strain the fascia.
• Sudden Activity Changes: Starting a new exercise regimen or rapidly increasing high impact exercise, without adequate preparation can overload the tissue.

2. Footwear Choices

• Shoes with inadequate cushioning or poor arch support can exacerbate plantar fascia stress.
• Wearing high heels or flat-soled shoes like flip-flops can alter weight distribution and strain the fascia.

3. Weight Gain

• Excess body weight, whether due to obesity or pregnancy, increases pressure on the plantar fascia, heightening the risk of injury.

4. Biomechanical Factors

• Flat Feet (Pes Planus): Individuals with low arches are prone to overpronation, increasing fascia tension.
• High Arches (Pes Cavus): Conversely, high arches concentrate pressure on the heel and ball of the foot.
• Tight Calf Muscles: Restricted flexibility in the calf or Achilles tendon can limit ankle mobility and increase plantar fascia stress.

5. Age and Tissue Degeneration

• Plantar fasciitis is most common in individuals aged 40-60. As we age, the fascia loses elasticity and resilience, making it more prone to injury.

6. Medical Conditions

• Conditions such as diabetes and arthritis can predispose individuals to plantar fasciitis due to compromised tissue health and healing capacity.

Symptoms of Plantar Fasciitis

The hallmark symptom of plantar fasciitis is a pain on the bottom of the heel, often described as sharp, stabbing, or throbbing. This pain typically worsens when walking or running, especially after a period of rest.

• First Steps in the Morning: Pain is often most intense when taking the first steps after waking up.
• After Inactivity: Prolonged sitting or inactivity can lead to stiffness and pain upon resuming movement.
• During Activity: While the pain may subside during moderate exercise, it often returns or worsens after prolonged activity.

Other symptoms may include:

• Tenderness along the arch of the foot.
• Difficulty raising the toes off the floor.
• Swelling along the arch of the foot.

Diagnosing Plantar Fasciitis

A thorough clinical examination is essential for diagnosing plantar fasciitis.

Key diagnostic steps include:

• Physical Examination: Palpation of the heel and arch to identify pain points and tenderness.
• Assessment of Biomechanics: Evaluating foot structure, gait, and range of motion in the ankle and calf.
• Imaging: Diagnostic ultrasound can confirm the diagnosis by revealing inflammation, thickening, or small tears in the plantar fascia.

Treatment Options for Plantar Fasciitis

Treatment aims to reduce pain, promote healing, and prevent recurrence. Approaches can be categorised into self-care, conservative therapies, advanced interventions, and surgical options.

1. Self-Care Measures

• Rest: Avoid high-impact activities to allow the plantar fascia to recover.
• Ice Therapy: In the earlier stages of this condition when there is acute inflammation, you can apply an ice pack wrapped in a towel to the painful area for 15-20 minutes every 2-3 hours.
• Supportive Footwear: It’s a good idea to wear shoes with cushioned heels and good arch support to alleviate strain. Avoid wearing very flat shoes like sandals, flipflops or ballet pumps.
• Stretching Exercises: Regularly perform gentle stretches targeting the calf muscles and plantar fascia.

For the calf stretch make sure that your heel is down on the floor. Hold for 30-45 seconds and repeat 3 times.

You can use a tennis or golf ball to gently massage and stretch the plantar fascia, along the length of your foot arch.

These can be done 2-3 times a day

2. Pain Management

• Over-the-counter pain relievers, such as paracetamol and ibuprofen, can help manage discomfort.

You should seek professional advice before starting any medication

3. Physiotherapy and Podiatry

A physiotherapist can design a tailored exercise program to improve flexibility and strengthen supporting muscles. Common techniques include:

• Calf and Achilles tendon stretches.
• Soft tissue massage to the plantar fascia and surrounding structures, especially the calves if they are tight.
• Plantar fascia-specific stretches (e.g., rolling a ball under the foot).
• Strengthening exercises for foot and ankle stability.
• Insoles and heel pads can provide additional support and cushioning.

4. Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that delivers powerful sound waves to the plantar fascia. Benefits include:

• Stimulating the body’s natural healing process.
• Reducing nerve sensitivity to alleviate pain.
• Promoting tissue repair and regeneration.

Studies show positive outcomes after 3-5 sessions of ESWT.

5. Ultrasound-Guided Injections

For persistent pain, injection therapy may be considered:

• Steroid Injections: A combination of local anaesthetic and corticosteroids can provide rapid pain relief by reducing inflammation.
• Platelet-Rich Plasma (PRP) Injections: PRP promotes healing by stimulating tissue repair and reducing inflammation. It is particularly effective for cases involving tears in the fascia.

6. Surgical Interventions

Surgery is very rare and reserved for severe, refractory cases. Options include:

• Gastrocnemius Release: Lengthening the calf muscles to reduce plantar fascia stress.
• Plantar Fascia Release: Making a small cut in the fascia to relieve tension.

Preventing Plantar Fasciitis

Preventive strategies are crucial to reduce the likelihood of developing plantar fasciitis or experiencing a recurrence:

• Gradually increase your exercise levels, both frequency and intensity to avoid overloading the fascia.
• Maintain a healthy weight to reduce stress on the feet.
• Wear supportive footwear, especially during prolonged standing or physical activity.
• Incorporate regular lower leg stretching and strengthening exercises into your routine.

When to Seek Professional Help

While self-care measures are often relatively effective, certain situations warrant medical attention:

• Severe or worsening pain that impedes your daily activities and quality of life.
• Symptoms persisting for more than a few weeks despite home treatment.
• If your sleep is being disrupted
• Tingling, numbness, or loss of sensation in the foot.
• Foot pain in individuals with diabetes, as it can indicate more serious complications.

Plantar fasciitis can significantly impact your quality of life, but with timely intervention and proper management, most individuals experience substantial improvement.

If you’re struggling with the relentless heel pain and discomfort of plantar fasciitis, I’m here to help you take the first steps toward relief.

As a dual-trained foot and ankle surgeon with a degree in sports medicine, I bring a unique perspective to your care. I don’t just look at your foot in isolation—I consider how your entire body moves and functions, particularly if you’re active or trying to get back to the sports and activities you love.

My goal is to help you recover fully, regain your mobility, and leave heel pain behind. I also have a team of Physiotherapists and Podiatrists who I work closely with, and can therefore ensure a holistic approach to your treatment.

Together, we’ll create a tailored approach to get you back on your feet and thriving!