PLANTAR FASCIITIS

 

This is a painful inflammatory condition of the plantar fascia on the sole of the foot which can typically take 6 -18 months to resolve. It is usually caused by a biomechanical fault resulting in abnormal pronation (rolling inwards) or excessive wear of the tissues. It is common after long periods of weight-bearing and is often also associated with the following:

- obesity

- weight gain

- jobs that require excessive walking on hard surfaces (hence used to be called “Policeman’s Heel”)

- shoes with little or no arch support

- inactivity

- tight calf muscles

The pain is felt on the underside of the heel and is often most intense with the first steps of the day. It can lead to a heel spur or bony outgrowth on the calcaneous.

 

Treatments are varied and are generally effective eventually.

 

1.The below are all carried out by the patient and are the initial line of attack.

- resting and keeping off the foot as much as possible

- aspirin & ibuprofen can relieve pain & inflammation

- stretching the leg muscles particularly the calf

- wearing stable shoes that give support & avoiding open-backed shoes & sandals as well as flip-flops.

- discontinuing aggravating activities

- weight loss
- putting a pillow at the bottom of the bed under the covers to keep your foot flexed during sleep

- massaging and stretching the sole of the foot before ALL weightbearing

 

2. If the above has not resolved the PF then the below treatments should be undertaken with the help of a professional:

- specialist exercises & massage to stretch the Achilles tendon and Plantar Fascia, perhaps using a special Foot Stretcher (see Products)

- cold compression therapy

- contrast hot/cold therapy

- arch support and heel lifts (over the counter products may help and prescription orthoses are often prescribed. The softer materials are more beneficial. All orthoses should be broken in slowly)- taping (carried out by a physiotherapist)

 

 

3. The final line of attack involves intervention by professionals and therefore is only used when all else has failed.

- corticosteroid injection can give temporary or permanent relief but can be painful.

- night splints can be used to keep the foot in a dorsiflexed position during sleep to improve calf flexibility and decrease morning pain. There are special “boots” available over the counter for this.

- ultrasound in itself has been found to be ineffective but is more successful when in combination with other treatments such as when used to guide needles (corticosteroid or ESWT)

- ESWT is extra corporeal shockwave therapy and has been successful with long-standing PF. It is non-surgical and involves reinflaming the area to promote blood flow and therefore healing.

- fasciotomy is a minimally invasive procedure in which an ultrasound guided needle is inserted into the inflamed tissues & is moved backwards and forwards to disrupt the fibrous tissue which proliferates as a result of the chronic inflammation.

- surgery such as plantar fascia release, is the last resort as it may not work and in fact may lead to other complications such as lowering of the arch

 

 

Although if you have it, Plantar Fasciitis can seem an all-consuming  problem, it most cases it does eventually clear up. This may take up to 18 months but there is so much you can do to help yourself. Back2toes are experienced at dealing with this problem. Book in for a course of special PF massage treatments, let us show you how to gently stretch and exercise the area and in most cases you will start to feel instant relief.