Plantar Fasciitis & Heel Pain

What is plantar fasciitis?

Plantar fasciitis is a very common cause of heel pain and is known by a number of different names including runner’s heel, policeman’s heel, plantar spur, calcaneal spur syndrome- the list goes on and on. The plantar fascia is a strong thick fibrous tissue running in the sole of the foot which attaches to the heel bone and fans out towards the toes. It is important in maintaining the arch of the foot.

What are the symptoms?

Generally it comes on gradually as a deep dull ache in the heel which comes and goes. It is often worse with the first few footsteps of the day or on standing after a long rest. Over time it can progress and become a sharper, more severe and persistent pain. Unfortunately for many it can be so severe that it severely affects daily life and can be very distressing.

What are the causes?

Plantar fasciitis means inflammation of the plantar fascia. The traditional theory is that repetitive stressing of the plantar fascia with weight bearing causes micro tears with resultant damage and inflammation at the calcaneal-fascial interface. It is now believed that the condition is in fact not truly inflammatory and more likely to be a chronic degenerative condition much like a tendinopathy.

There are many causes of chronic heel pain and it is important to not assume plantar fasciitis is always the cause. Other potential causes which should be excluded to ensure appropriate treatment is given are-

• Nerve entrapment around the heel.
• Arthritis of the subtalar joint.
• Plantar fascia rupture.
• Stress fracture of the heel bone (calcaneum).
• Fat pad syndrome- thinning of the fat pad in the sole of the foot.
• Tendonitis of the toe flexor tendons.

How is it diagnosed?

The diagnosis is generally fairly straightforward. A single consultation with a Consultant Orthopaedic Foot & Ankle Surgeon tends to be all that is required.

It is not normally necessary to undergo any further investigations unless your surgeon has concerns that there could be another cause for your heel pain. X-rays are rarely helpful. There is much written in the medical literature on the importance of heel spurs but it is now widely accepted that these are generally a red herring- they do not tend to be the cause of the heel pain, they do not increase the risk of getting heel pain and with rare exceptions they do not need to be surgically removed. When other causes are being considered for heel pain it may be necessary to undergo an MRI scan and very occasionally nerve conduction studies.

Can it become worse?

For the vast majority of people this is fortunately a condition that settles down given time. Unfortunately this can take up to two years and even then some people are left with chronic and severe pain.

There are a several factors that can make the condition worse-

• Hard soled and poorly fitting shoe wear.
• Running and activities that cause repetitive stressing of the plantar fascia particularly when performed on hard surfaces.
• Tightness of the gastrocnemius muscle or hamstrings which can lead to less movement across the ankle joint.
• Increased body weight.
• Abnormal foot alignment such as high arched and flat feet.

How can it be treated?

The vast majority of the time non-operative treatment measures used alone or in combination control things well. These include-

• Rest, ice, compression and elevation (RICE) during an acute flare up.
• Simple pain killers may be prescribed by your doctor.
• Comfortable shoes.
• Avoid aggravating activities such as running- try cycling or swimming for a while.
• Physiotherapy.
• Insoles and soft heel pads.
• Taping.

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