Plantar Fasciitis

Plantar fasciitis (heel spur syndrome) is a common problem among people who are active in sports, particularly runners. The plantar fascia is a thick fibrous material on the bottom of the foot. It is attached to the heel bone then fans forward towards the toes and acts like a bowstring to maintain the arch of the foot.

Problems can occur when part of this inflexible fascia is repeatedly placed under tension, as in running. Tension causes an overload that produces inflammation usually at the point where the fascia is attached to the heel bone, the result of which is pain. Plantar fascia injury may also occur at the mid sole or near the toes. Since it is difficult to rest the foot the problem gradually becomes worse as the condition is aggravated with every step. In severe cases the heel is visibly swollen. The problem can progress rapidly and therefore treatment must be started as soon as possible.

You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis. Contributing factors include: poor shoe support, running, increasing age, sudden weight gain, sudden increase in activity and a family tendency.

Symptoms of Plantar Fasciitis

It starts as a dull intermittent pain in the heel, which may progress to a sharp persistent pain. Classically it is worse in the morning with the first few steps, after prolonged sitting, or after standing or walking and at the beginning of sporting activity. The pain classically occurs again after arising from a midday lunch break.

Treatment of Plantar Fasciitis

Treatment of plantar fasciitis may take longer than one would expect, especially if the condition has existed for a long time. Losing weight, good shoes and sedentary activities all help the injury to mend. The use of ice to the inflamed area several times a day can also help. Anti-inflammatory medication used with heel pads can help relieve sudden onset pain, however if there is no improvement after 2-3 weeks you may need an injection of cortisone or local anaesthetic directly into the tender area. Physiotherapy can also play its part in strengthening the weakened plantar fascia.

Surgery is rarely required for plantar fasciitis. It would be considered only if all forms of more conservative treatment fail and if the pain is still incapacitating after several months of treatment. The required surgery involves partial release of the plantar fascia, and can involve release of the main tibial nerve at the same time.

When recovering from plantar fasciitis it is important to returns to any sporting activity slowly, allowing pain to be the guide.

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Clinicians

Emergency clinicians

Mr. Brian Cohen
MD FRCS (Tr&Orth)
Mr. Jig Patel
MB BS FRCS (Tr&Orth)
Mr. Rohit Madhav
MB BS FRCS (Tr&Orth)
Mr. R. Lloyd Williams
MB BS FRCS (Tr&Orth)
Mr. Sean Curry
MB BS FRCS (Tr&Orth)