Plantar Fasciitis / Plantar Heel Pain

What is Plantar Fasciitis?

This is a common cause of heel pain and usually comes on gradually. It is more common in runners, people who have a high BMI and in those who wear footwear that is not supportive to the foot.

The plantar fascia is a thick band of tissue that runs from the heel to the toes on the inner side of the sole of the foot and it can become painful if it becomes inflamed. The pain often varies in severity, typically being worse first thing in the morning when the foot and ankle feel stiffer and improving as the foot becomes stretched out. This early morning pain can be helped by using a splint that holds the foot and ankle in a neutral position overnight. Standing and even walking can be made difficult and painful by this condition.

How is it diagnosed?

Diagnosis of the condition by a specialist is usually straightforward, and further tests are usually not necessary.

Foot x-rays are often performed to exclude other causes for heel pain and scans may be performed as needed.

How is Plantar Fasciitis treated?

Plantar fasciitis treatment starts with simple anti-inflammatory tablets and painkillers, together with plantar fascia stretches and, where necessary, insoles (orthotics). The latter can help support the foot better and to take the pressure off the plantar fascia by spreading the load across the whole foot.  As already mentioned, night splints may also be helpful in preventing severe early morning symptoms and helping the plantar fascia to heal.

What is the role of Shock Wave Therapy?

Sometimes the condition does not respond to these measures and becomes longstanding (chronic). In these cases other treatments are considered. A steroid injection into the heel may be performed. This is something that we do not recommend in general as it does not usually result in a permanent cure through a healing response and it can cause damage to the plantar fascia (especially multiple injections) and loss of the normal fat pad that lies over and cushions the heel bone. We prefer to use shock wave therapy as the next line for plantar fasciitis treatment and have had excellent results with this needle-free, outpatient procedure in 70% of patients. This treatment induces a healing response and so is more likely to result in the condition being cured.

As a last resort, in patients with severe symptoms that have not responded to all other treatments, surgery is considered. This involves detaching the plantar fascia from the heel bone. Unfortunately even this can sometimes fail to cure the condition.

We have found shock wave therapy to be 70-80% successful for plantar fasciitis treatment in a wide range of patients; some of whom have had the condition for a number of years.