This is by far the most common complaint we get in the clinic every week. It affects men and women of all ages over the age of 18, but is more commonly seen in patients aged 40-60.
In the early stages, it is classified as plantar fasciitis when there is an acute phase and inflammation occurs along with swelling. After around 3 weeks, this inflammatory response from the body stops and the term plantar fasciopathy should be used. This is just a more accurate way of describing the condition, but plantar fasciitis is still used as it’s a term most are familiar with.
Anatomy
The plantar fascia is a fibrous band that runs from the heel to the toes via a central cord but there is a thinner medial and thinner lateral band as well. All 3 can be affected but most often it’s the central band. Pain can be at the attachment on the heel bone (insertional) or along the fascia itself in the arch (non insertional). Pain can also be felt closer to the attachment at the toes, specifically under the 1st toe.
Signs and Symptoms Of Plantar fasciitis
Start up pain is the main key here. Pain when you first put weight on the foot in the morning, after sitting for more than 15mins, after driving. Once you get moving the pain will ease and generally will be described as manageable, until you stop your activity and the pain will start to return, especially when you then sit and get up. Once you get into bed, while it may throb for a short period around the heel and arch of the foot, the pain will settle and you should not have pain waking you up or keeping you from sleeping. Expect pain again though if you have to get up in the middle of the night for the bathroom or to get up to a child.
What causes Plantar Fasciitis
This is a very common question I get from patients. The answer is not always simple and we have no one single thing that causes it, in fact the research indicates that we don’t truly know the cause, but, we know it is very commonly seen with patients who have tight calf/soleus muscles (muscles in the backs of the legs), over weight patients, patients wearing poor footwear or footwear not designed for what they are using it for (think running in a pair of fashion trainers) and in patients who have recently taken up exercises and have done to much to quick.
Diagnosis
Symptoms and palpation are generally accepted as good enough to be able to diagnose plantar fasciitis, however, it does overlap with multiple other conditions that cause heel pain, so imaging is great way of confirming clinical suspicions. Diagnostic ultrasound is a quick and painless way of imaging the plantar fascia and helping to confirm the diagnosis, going by the size of the fascia and the appearance. MRI is also useful in fully assessing the plantar fascia. XRAY and CT would not be overly useful for this problem.
Differential diagnosis
Many things can cause heel pain which is where the difficulty can be with patients self treating or self diagnosing. There are more than 15 possible causes of heel pain, each with their own subtle signs and symptoms but they can overlap with plantar fasciitis and its possible to have 2 conditions at once. This is where imaging can play an important role in helping to distinguish. The most common differential diagnosis of heel pain I see are:
- Tarsal Tunnel Syndrome
- Baxters nerve entrapment
- Inflamattory arthropathy (Rheumatoid, sero negative, psoriatic etc…)
- Fat pad atrophy
- Fat pad syndrome
- Plantar calcaneal bursitis
- Tibialis posterior tendonoitis
- Spinal radiculopathy
Plantar Fasciitis Treatment
Once plantar faciopathy is confirmed, we normally look at what we think the underlying cause could be. Stretching the muscles in the backs of the legs is often a good starting point but also strengthening those muscles as well along with strengthening the plantar fascia. Orthotics ranging from off the shelf options, of which there are many, to a custom made orthotic (made specifically to your requirements) are possibly an option, but these are not always needed. Footwear changes can help to reduce the impact on the heel as well as strapping techniques to help bunch the fat pad and provide cushioning or to support the foot better in the short term, again to offload the tissue that is irritated and painful.
These options are typically our first line treatments, meaning the things we try first. If they do not sufficiently reduce your pain, we will consider our next treatment options.
Shockwave
This is a well researched treatment that has been available for years, is very safe and very effective for tendon problems such as Achilles tendonitis, patella tendonitis and plantar fasciitis. We offer radial shockwave therapy at Happy Feet NI and find around 7 out of 10 patients get significant improvement or full resolution when done with a strengthening and loading programme.
Injections
A Steroid injection is another possible treatment option for plantar fasciitis or fasciopathy and at Happy Feet NI, we offer ultrasound guided steroid injections to make sure we get accurate placement of the steroid to maximise the outcome.
Surgery
Last line option when all else has failed and you are still in chronic pain, onward referral to orthopaedics for surgical consideration can be required. At Happy Feet NI, we can arrange that referral for you.