What is Plantar Fasciitis?
This is a common condition that is normally a result of inflammation or injury to the strong structure that runs from the heel bone to the base of the toes along the sole of the foot. It can be a result of trauma, pregnancy, inflammatory conditions, endurance activities or simply bad luck!
What are the symptoms of plantar fasciitis?
Pain is usually worse first thing in the morning or after periods of rest. A patient will often describe a sharp pain shooting through the heel from the sole of the foot. It is often painful to bear weight through the heel and patients will often be visibly limping. Early symptoms may simply be that of an ache in the foot after a period of exercise or standing.
How is plantar fasciitis diagnosed?
Clinical examination by a foot and ankle specialist is the key to an accurate diagnosis. Ultrasound scans and MRI can be very helpful in confirming the diagnosis and helping to plan rehabilitation.
What are my options for treatment?
Most individuals will recover well with the help of a physiotherapist. In addition to general foot and ankle rehabilitation, the physiotherapist will look at calf tightness as this has been shown to be a big driver of the symptoms. If a patient remains tight in the calf and symptomatic despite physiotherapy, a small procedure on the back of the calf called a proximal medial gastrocnemius release can take away tension in the calf and significantly improve symptoms.
If the patient remains symptomatic despite resolving the tightness in the calf, shockwave therapy can be very effective at treating the underlying pathology.
Direct surgery to the plantar fascia is becoming less and less popular due to its limited efficacy. A last resort is injection therapy and this is something that may be required on a regular basis to control symptoms. The reason that injections are the last resort is due to the risk of damaging the fat pad under the heel. Damage to this structure by the steroid in the injection can lead to even more significant symptoms. There is no role for a ‘blind’ injection in the surgery setting. This should always be done under Ultrasound or X-ray guidance.
