Plantar fasciitis

This condition is relatively common and known as policeman’s heel, in brief, it is inflammation or wear and tear of the soft tissues. It often occurs after extended periods of walking on hard surfaces or in different shoes (flip flops for example). It is most obvious when you take your first step in the morning and after sitting for prolonged periods.

The average plantar heel pain episode lasts longer than six months and it affects up to 10-15 percent of the population. However, approximately 90 percent of cases are treated successfully with conservative care. 

Common causes include:

• overweight
• loss of ankle range of movement
• fallen arches with excessive pronation
• poorly fitting shoes.

Often diabetics suffer from this condition.

Treatments

Take your usual choice of anti-inflammatory regularly. Follow instructions on the packet and inform the pharmacist of any conditions that you suffer with (e.g. asthma, stomach ulcers, or if you take warfarin).

Heat the sole of your foot first thing in the morning (e.g. rub the sole of your foot or put the plug in the bath while showering). Rest your heel on a bag of ice wrapped in a damp cloth for 20-30 minutes at the end of the day. Or try rolling an ice cold water bottle or golf under the arch of the foot.

Avoid walking on hard surfaces for over extended periods. Try and take smaller steps. Always wear soft shoes. Try and avoid walking barefoot.

Stretch your calves after walking. Face a wall and step back. Keep your heels flat on the ground and feet together. Lean forward onto a wall keeping your knees straight until you feel tension in your calf muscle (Picture 1). Hold still for at least 30 seconds.

Repeat with the knees slightly bent (Picture 2). Hold for 30 seconds.

Stretch the sole of your foot before standing, after sitting or lying down. Firmly hold all the toes and bend them back until you feel a stretch in the arch of your foot.

Alternatively for a stronger stretch, place toes on a wall with heel on floor. Slide toes down wall to bend them back, then bend knee and put weight through the arch until a stretch is felt in the arch. Hold for 30 seconds. (Picture 3)

Image: copyright Physiotools Ltd. All rights reserved. Used with permission of Physiotools Ltd.

Recent evidence has suggested that soft tissue mobilisation (massage) over your calf and plantar fascia (sole of foot) could be beneficial in reducing pain and improving function when combining this with stretching exercises. Please be guided by your physiotherapist.

Certain taping techniques can help the pain experienced on the first few steps. It is helpful in more short term flare- ups. It can be used to bridge the gap whilst waiting for foot over the counter orthotics, or as a second line of treatment custom made orthotics may be beneficial but costly. Night splinting e.g. Strasbourg sock, only tends to be helpful with other treatment strategies. However, the evidence for its effectiveness is contrasting.

There is some evidence to suggest that acupuncture can be beneficial in the treatment of heel pain. There is no evidence to support ultrasound therapy.

Non conservative treatments

In general steroid injections should be considered after all suitable and available conservative measures have been tried, if symptoms are having a significant impact on the patient and short- term relief of symptoms are required. There are known adverse effects to steroid injection including post injection flare-up of pain (may last for several days), rarely fat pad atrophy occurs, but a return of symptoms within 1 month has been known cause long-term pain and ongoing disability.

Patients should possess long term symptoms and have undergone treatment for at least six months prior to consideration for plantar fasciotomy surgery, removal of the plantar heel spur or autologous blood injection which promotes healing through the action of growth factors.