Plantar Fasciitis

Plantar fasciitis (fashee-EYE-tiss) is a degenerative condition affecting the point where the plantar fascia arises from the heel bone (calcaneus).

The plantar fascia is a normal structure, a thin membrane running through the sole of the foot, just below the skin and its underlying protective fat layer. The plantar fascia degenerates as a result of minor but repetitive trauma. This causes inflammation and pain under the inner side of the heel.

Whilst almost 50% of people with plantar fasciitis pain have a heel spur, the spur itself is not the cause of the pain. Rather, spurs are caused by chronic plantar fasciitis. This is the reason for the high association. Surgical excision of a heel spur is therefore not the cure for heel pain!

Plantar fasciitis can occur in anyone, but it is more common if you are female, middle-aged and overweight. It is also more common in rheumatoid arthritis and other inflammatory “arthritis-like” conditions.

Pain from plantar fasciitis occurs under the inside of the heel and is often described as being like a “stone bruise”. It usually evolves gradually. Typically, the pain is worst when arising from bed in the morning, or standing up after a long period of sitting. It usually improves dramatically during the first 10 minutes of standing or walking, then gradually worsens again through the day. It always improves with rest.

Plantar fasciitis usually responds well to non-operative treatment. Surgery is only rarely required. However, when the pain has been long-standing or very severe, improvement can be very slow.

Most people respond well to a program of stretching exercises and avoidance of activities which exacerbate pain. There is usually some improvement after 10 days, and significant relief after 2 months. Stretching is the mainstay of effective treatment! It should be performed religiously every day!

Stretch 1 must be performed on waking in the morning, before getting out of bed:

• Sit up with the knee straight.
  
• Sling a towel, sheet or belt around the ball of the foot like a stirrup, hanging onto the ends with both hands.
  
• Pull back hard on the stirrup to stretch both the heel cord and the plantar fascia.
  
• The stretch must be steadily maintained for at least 3 minutes.

Stretch 2 must be performed on the edge of a step:

• Hang onto the handrail.
  
• Stand on the edge of the step so that the heels drop down.
  
• Allow full body-weight to bear down on the heels.
  
• Maintain the stretch for 3 minutes.
  
• Repeat the manoeuvre 3 times each day.

Other effective treatments include: use of a 2cm heel raise, a heel-cushioning and shock-absorbing Tuli heel cup and weight loss. If these measures are unsuccessful, a 6-week period of ankle immobilisation in a special walking boot, can be effective. Injections of cortisone should be avoided as they can permanently damage the heel! Surgery is a last resort only; it can take months to recover and the results are inconsistent and unreliable.