What is Plantar Fasciitis?
Plantar fasciitis is a painful condition of the foot caused by repetitive strain to the plantar fascia. This is a fibrous band of soft tissue connecting your heel bone to your toes. It helps to reinforce the arch of your foot and acts like a ‘bow string’ to stiffen your foot when you walk.
Plantar fasciitis is a relatively common condition that affects approximately 1 in every 10 adults. Both athletes and non-athletes can suffer with this condition. It tends to be more common in people whose occupations involve standing on hard surfaces for long periods, and those who carry out sporting activities, such as long distance running.
Pain is felt around the heel bone, usually on the sole of the foot. People often complain of ‘first step’ pain which settles during the day and with exercise, but is worse at the end of the day.
Sometimes an X-ray may show a heel spur, where the plantar fascia inserts on the heel bone. This can be mistaken as the cause of plantar fasciitis. 3 in every 10 people have a heel spur and few of them have heel pain. Similarly, many people with plantar fasciitis do not have a heel spur.
Treatment options range from non-operative to operative.
NON-OPERATIVE MANAGEMENT
The mainstay of treatment is conservative therapy. These include can relative rest, simple analgesia and anti-inflammtory medications. Regular Stretching is important. Other interventions can include orthotics, PRP injections or steroid injections.
Stretches
Regular stretching of the plantar fascia is a very important part of treatment. Carry out these stretches with your affected foot at least twice every day. Hold each stretch for 1 minute.
Plantar Fascia – Standing. Place the front of your foot and toes against a wall and lean forwards from the ankle.
Plantar Fascia – Sitting. Sit in a chair with your affected leg crossed over your good one. Grab hold of your toes and bend them backwards until you can feel the stretch in the sole of your foot.
Soleus muscle. Using a wall for support, plant your feet flat on the floor, one behind the other.
With your front knee bent, lean forwards, reducing the angle between your foot and your shin, until you feel the stretch in the back of your calf muscle in the front leg.
Do not let your heel come off the ground.
Gastrocnemius muscle. Using a wall for support, plant your foot flat on the floor behind you.
With your leg straight, lean forwards, reducing the angle between your foot and your shin, until you feel the stretch in the back of your calf muscle in the leg you have planted behind you. Do not let your heel come off the floor.
Frozen bottle rolling
Take off your footwear and place your foot on a frozen bottle of water.
Roll the bottle backwards and forwards underneath the arch of your foot.
Continue rolling for 5 minutes. Do this 2 to 4 times a day.
PRP Injections
PRP ‘Plasma Rich Protein’ injections have been shown to reduce pain effectively, with evidence showing improved benefit compared to cortisone injections.
PRP injections involve concentrating specific proteins from a blood sample. Usually 3 injections are performed over a 6 week period.
At MOG a PRP service is run with a specialised nurse for PRP preparation.
Cortisone Injections
Cortisone injections decrease inflammation and pain. These can be very effective for plantar fasciitis, however the response can vary widely for individuals, and it may only last a few weeks.
Orthotics
An orthotic with an arch support may help to support the plantar fascia when walking. At MOG a range of Vasyli is stocked, or a referral to a Podiatrist may benefit.
OPERATIVE MANAGEMENT
Surgery is only indicated if all Non-Operative measures have failed. This is because the outcome is variable and recurrence can occur. Surgery involves releasing the plantar fascia from its insertion. This is done with either an endoscopic technique or open.
Recovery involves resting for 2 weeks, then protected walking in a boot for up to a month.