Orthotics for Plantar Fasciitis Pain

What is plantar fasciitis

Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia is a strong ligament that runs from the bottom of the heel to the base of the toes through the sole of the foot. It helps to support the arch of the foot and it works like a bowstring. Given that this area is taking the weight of the whole body and more, the forces going through the plantar fascia are very high and it may be damaged causing pain and functional limitation. Plantar fasciitis is the term used to describe a group of degenerative conditions that have in common a painful heel that is made worse when loaded. The cause of plantar fasciitis is unclear, and despite the term fasciitis implies inflammation of the fascia, it is uncertain if there is much or any inflammation and instead the condition involves degeneration or wear and tear. Independent of what exactly happens in the fascia, it is known that the symptoms can be quite limiting and that the appropriate treatment should be implemented early on to obtain the best outcomes.

Patients with plantar fasciitis tend to describe heel pain every time that they take a step or bear weight on the affected heel. The pain is localised at the bottom of the heel or at the bottom of the mid-foot towards the toes. It tends to develop over time and is generally worse first thing in the morning or when initiating an activity from rest. It is made worse by climbing stairs or after prolonged activities that put pressure on the fascia and heel areas. Most often than not the pain is worse after than during the activity.

Plantar fasciitis and heel spurs

Because it is common to see heel spurs on an Xray of a patient affected by plantar fasciitis, it was thought that heel spurs were the cause of plantar fasciitis. Modern studies have shown that this is a case of correlation rather than causation and actually the direction of the effect is the opposite. Heel spurs can be a consequence of plantar fasciitis and be part of the long-term signs observed after the fascia becomes inflamed, degenerated and ultimately calcified, creating the shape of a heel spur. Furthermore, studies revealed that by removing the heel spur the symptoms are not made any better and so the spur is rather a red herring but does not require particular attention per se.

Plantar fasciitis risk factors are obesity, long-distance runners, foot biomechanical issues or particular shapes such as high-arches of flatfoot, tight Achilles or calf muscles, stiff shoes without much support.

First of all your doctor must ascertain that your pain is caused by plantar fasciitis as there can be other differential diagnoses that present similarly but are treated differently. Once properly diagnosed there are several treatments that have shown a positive track record.

Treatment for plantar fasciitis

The treatment of plantar fasciitis will be a combination of non-surgical methods and surgery is rarely needed and only when conservative management fails.

In addition to anti-inflammatory medication, physiotherapy is the mainstay of treatment for plantar fasciitis. Depending on the observed biomechanical issues, the focus will be on the particular area that needs addressing. Eccentric stretches and Extracorporeal Shockwave Therapy have shown their scientifically-proven results. More on treatment on this other news entry.

Orthotics for Plantar fasciitis

Orthotics are the other modality of treatment that will alleviate the pain caused by plantar fasciitis and address poor biomechanics or foot shape. 

Initially cushioned gel pads acting as shock absorbers will help and can be used in everyday shoes as well as running shoes. In addition to the cushioning effect they will offload the tight calf muscles providing better motion and reducing pressure in the heel.

Custom made insoles will be ideal in those cases when the foot shape is likely the culprit and will address a flat foot, high arches, or other deformities. Our podiatrists will be able to measure your feet and provide a custom insole that fits perfectly to your own feet.

Night splints to stretch the ankle and fascia have been advertised but their effect is not fully proved. Having said that, some patients will find comfort and wake up with less pain when using them, while others are terribly bothered by them in bed. 

In cases of an intense flare up or with small plantar fascia tears, a period of immobilisation in a walker boot will settle things down while you can continue to walk around more comfortably than in normal shoes.