Who is at risk? This condition is more common
in people who spend a lot of time on their feet, and in those with
excessive bodyweight, flat feet, high arches or tight lower limb
muscles.
How is the diagnosis made?
Diagnosis is made from your symptoms and a physical examination.
Ultrasound examination confirms and quantifies the swelling of the
plantar fascia.
An X-ray may show a heel spur, which is the
result of chronic traction on the plantar fascia at its insertion. The
bone spur is the result of traction and not the cause of the condition
or pain.
How is the condiiton treated? The aim of treatment is to reduce pain and promote healing and to address the underlying biomechanical causes.
1. Treating the pain To reduce the plantar fascia swelling, there are three approaches:
- Rest and pain-relief medication
This
is effective in about 40% of patients and worth a try in the early
stages, i.e. if symptoms have been present only for a few weeks.
- Cortisone injection
This is effective
in about 60% of patients. Cortisone is an anti-inflammatory medication
and, hence, effectively reduces the swelling. Unfortunately, it also
increases the risk of plantar fascia tears and heel pad atrophy. The
risk of tear increases with the number of previous cortisone injections
and with the intensity of physical activities. Hence, it is not
recommended in active individuals, unless there is great urgency in
relieving the pain. - Extracorporeal shock wave therapy (ESWT)
This is effective in 80% of the patients and works by stimulating the
repair process at the insertion of the plantar fascia. ESWT is safe,
does not increase the risk of ruptures, and can be safely repeated if
symptoms recur. However, it is slow to work and you may need to lower
your physical activity intensity for several weeks to allow repair of
the plantar fascia. The treatment is also costly.
2. Addressing the underlying biomechanicsa) Daily plantar fascia and calf stretches
These are recommended to reduce the tension in the plantar fascia. You
should hold the plantar fascia stretches for 30 seconds and repeat 3
times for each side, repeat the whole process 3 times daily.
- Plantar fascia stretchsee pictures
1. Stand close to a wall with your hands on it for support.
2. Slide your toes down the wall until the ball of the foot touches the
floor. The toes should be slightly bent in this position to maintain
tension on the plantar fascia.
3. To increase tension, bring your knee forward to touch the wall. - Gastrocnemius Stretchsee pictures
- Soleus Stretchsee pictures
b) Splints Worn at night, splints may also be prescribed to stretch the plantar fascia while you sleep.
c) Customised insoles
To allow one to stand without excessive load on the plantar fascia,
customised orthotics can be made. These have a built-in inside arch
support, longitudinal groove, and an aperture to reduce loading and
traction in the plantar fascia.
Will the condition recur?
As it may be difficult to remove the underlying causes completely (i.e.
prolonged standing at work), some patients experience recurrent
episodes which may be interspersed with pain-free periods (lasting
months or years). Attacks are often triggered by changes in activity,
footwear or weight gain.
To prevent plantar fasciitis, you should:
- Avoid walking barefooted. Always wear sippers when indoors.
- When outdoors, always use customised insoles.
- Increase your exercise gradually and pull back when you sense the symptoms recurring.
How do I get treated? You will need to see your doctor, who will confirm the diagnosis and decide on the appropriate mode of treatment.