Plantar Fasciitis Treatment
What is plantar fasciitis?
Also known as Policeman’s heel, plantar fasciitis is one of the most common causes of heel pain. The plantar fascia is a strong ligament or band that supports the arch of the foot and connects the heel bone to the front of your foot, all the way to the base of the toes.
What causes plantar fasciitis?
Excessive load or overuse placed in the plantar fascia can damage it and in turn irritate it or create inflammation. The most affected area is where it inserts onto the bone as the high stress experienced is beyond the body’s tolerance and repair abilities.
In the majority of cases no obvious reason might be accountable for the development of plantar fasciitis, but there are multiple subtle signs that can lead to its diagnosis if examined carefully. Some factors that have been associated with plantar fasciitis are:
- Biomechanical foot imbalance such as high arches
- Repetitive impacts (common in runners)
- Tight calf muscles
- Recent change in activity or shoewear
What is the treatment for plantar fasciitis?
The vast majority of patients (90%) affected by plantar fasciitis will improve with non-surgical treatment. Depending on the duration of symptoms the results may not be noticed until months after the implementation of the correct measures but a steady improvement should be expected.
The following non-surgical strategies have all been shown to be effective to treat plantar fasciitis:
- Insoles – Cushioned insoles or heel gel pads will reduce the strain going through the plantar fascia that occurs as the heel strikes the ground.
- Physiotherapy – An exercise programme guided by a physiotherapist will aim at strengthening the calf muscles and stretching the plantar fascia.
- Plantar fasciitis stretching – Eccentric calf stretches – This specific type of calf muscle exercise will also stretch the plantar fascia and has been proven to be one of the best evidence-based treatments.
- Night splints for plantar fasciitis – Can help stretch the fascia at night and avoid the common early morning pain. The drawback is that many patients find them uncomfortable to sleep with and their effect is only moderate. Other plantar fasciitis socks or supports are of less proven efficacy.
- Steroid Injections – They should be prescribed cautiously due to the small risk of fascial tears but for the right cases they are a powerful anti-inflammatory solution, although the effect is only temporary.
- PRP (Platelet-rich Plasma) injection – It is a very effective alternative to steroid injections without the potential side-effects, as it uses your own blood healing properties to address the plantar fasciitis.
- Shockwave therapy – This well-proven technique imparts impulses onto the heel with a specific device that stimulates the healing process of a damaged fascia.
Surgery for plantar fasciitis
Surgical treatment is only recommended after 6 to 12 months of well performed non-surgical therapy, as there is a good chance that symptoms will fully improve during this period of time without the need for surgery.
In those very resistant cases that failed to improve after adequate treatment, surgery can be a very successful alternative. There are mainly two forms of surgery, one that acts on the fascia directly and another one that acts on the tight calf muscles.
- Plantar fascia release: The plantar fascia ligament is partially cut to relieve tension and allow for the tissue to heal. The fascia is approached via a small incision at the inside of the heel. It may require a couple of weeks of crutches when walking to let the wound heal properly.
- Calf muscle release (gastrocnemius): This is a type of surgery indicated when the range of motion of the ankle is limited due to tight calf muscles. It is known that this has an effect on the plantar fascia and its ability to tolerate load and activity. The procedure is done at the back of the knee and through a minimally invasive incision (<4cm) the muscle is released and stretched. It can be performed under local anaesthetic and the recovery is very fast as it allows for full weight bearing immediately given that the wound will be away from the heel. By releasing the calf muscles the plantar fasciitis can in turn be cured.