Causes

Your foot is a tremendously strong structure that can withstand great loads during activity. The arch of the foot is maintained by the bones, muscles and ligaments. A vital structure is the fibrous band of tough tissue, the plantar fascia, which connects the heel to the base of the toes. If this becomes damaged it may become inflamed and painful. Without treatment eventually it becomes tight and vulnerable to further injury and inflammation. The first few steps out of bed in the morning usually cause severe pain in the heel of the foot.

People with very flat feet or very high arches are more prone to plantar fasciitis as too are women, the overweight or those in a job that requires a lot of walking or standing on a hard surface. An acute tear of this structure can occur as a sports injury, especially if your calf muscles are tight, which restrict how far you can stretch up your ankles.

Diagnosis

The diagnosis is usually made by examining the foot. The role of the surgeon is to exclude other unusual causes of heel pain, fat pad incompetence, acute tear, chronic thickening of the plantar fascia or a calf contracture, or to establish if there is an underlying biomechanical reason. If the heel pain is failing to settle then an x ray may help exclude some of the other causes such as a stress fracture of the calcaneum. For a resistant or atypical case more advanced imaging with a MRI scan may be required.

Treatment

Stretching is the best treatment for plantar fasciitis. It may help to try to keep weight off your foot until the initial inflammation goes away. You can also apply ice to the sore area for twenty minutes three or four times a day to relieve your symptoms. Often your GP will prescribe a non-steroidal anti-inflammatory medication such as ibuprofen or naproxen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.

About 90% of people with plantar fasciitis improve significantly after three months of stretching.

If you do not treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk. Explanation of the stretching techniques for the calf and plantar fascia can be explained by a local physiotherapist from our local team of experts or read from https://www.footcaremd.org/conditions-treatments/heel/plantar-fasciitis.

Alternatively you can see the techniques for stretching the calf muscles on this link to  Oxford University NHS Hospitals. https://www.youtube.com/watch?v=-IMZ90bI0Io&feature=youtu.be

A shock-absorbing insole, such as a rubber heel pad may help especially if there is also damage to the normal pad of fat under the skin of the heel.

If the early morning pain is severe you may benefit from wearing a splint at night. We may discus an injection of steroids into the most tender area.

Recent evidence has supported the use of extra-corporal shock wave therapy to speed up a recovery, which is rather prolonged and slow. The Cotswold Foot and Ankle Clinic offer this treatment.

Surgery

Rarely surgery may be indicated to release a very tight chronically contracted plantar fascia, or to correct an underlying abnormality.