• How to Treat & Prevent Plantar Fasciitis

    Medically reviewed by Katie Knapton, MSCP HCPC on 29th October 2021

    What is Plantar Fasciitis? 

    Plantar fasciitis or a better term is actually plantar fasciopathy is a common foot condition that causes heel pain and pain in the sole of the foot. Plantar fasciiopathy is an overload injury and associated with a degenerative process similar to tendinopathy but in the toplantar fascia, a fibrous sheath that runs most of the length of the sole of the foot. It attaches between the heel bone and the bones at the base of the toes, covering the small muscles in the sole of the foot. During walking and running, as you ‘toe-off’, the plantar fascia becomes taut and helps the foot act as a lever to push off with force. It is one of the primary stabilising structures of the arch on the inner side of the foot.

    Plantar fasciitis

    What Causes Plantar Fasciitis & Who is Affected by it?

    Plantar fasciitis or a better term is actually plantar fasciopathy is a common foot condition that causes heel pain and pain in the sole of the foot. Plantar fasciiopathy is an overload injury and associated with a degenerative process similar to tendinopathy but in the toplantar fascia, a fibrous sheath that runs most of the length of the sole of the foot. It attaches between the heel bone and the bones at the base of the toes, covering the small muscles in the sole of the foot. During walking and running, as you ‘toe-off’, the plantar fascia becomes taut and helps the foot act as a lever to push off with force. It is one of the primary stabilising structures of the arch on the inner side of the foot.

    Plantar Fasciitis Symptoms

    Plantar fasciitis produces foot pain over the inside of the heel and this usually radiates down the inside of the sole of the foot. This foot pain usually occurs with activity and is also typically present in the morning when taking the first steps of the day or when standing after prolonged sitting. The band tightens up with inactivity and then loosens as you walk and move around again.

    How Do I Know If I Have Plantar Fasciitis?

    Plantar fasciitis can be diagnosed by a doctor or physiotherapist, if pain is present on touching the affected area, and/or on stretching the plantar fascia (by pulling the toes up). The diagnosis of plantar fasciitis can be confirmed on an ultrasound scan, when the fascia has a thickened appearance. In a small number of cases of heel pain, that fails to respond to normal treatment, it may be necessary to get an x-ray to rule out other conditions such as a bony spur on the heel bone or a fracture of the heel bone.

    How to Treat Plantar Fasciitis

    • Consult a sports injury expert
    • Apply ice packs/cold therapy for pain relief
    • Stretching and strengthening exercises
    • Wear a night splint to stretch the plantar fascia
    • Tape the foot for effective treatment
    • Support the inner arch with insoles

    In most sporting individuals the cause is overuse and the most important advice is to allow adequate rest, to take some of the strain off the plantar fascia and embark on a graduated loading and stretching programme. The foot and ankle supports can be effective in the treatment of plantar fasciitis. Plantar fasciitis supports are designed to reduce strain on the plantar fascia and apply compression to help reduce swelling and discomfort.

    Plantar Fasciitis Insoles 

    In some cases of plantar fasciitis there may be a problem with the biomechanics of the foot, contributing to the problem. The usual findings are a foot that ‘over pronates’, where the inner arch of the foot rolls over too much during walking and running. This can lead to tightness in the achilles tendon and recent research has suggested that a tight achilles tendon can increase strain on the plantar fascia. An insole that supports the inner arch of the foot can help to remedy this. Stiff joints around the foot and ankle can be treated using mobilisation, where the physiotherapist gently moves the joints manually to remove the stiffness and restore the normal range of movement. Conversely, there may be excessive ‘pronation’ and an insole that supports the inner arch of the foot may be helpful in alleviating strain on the plantar fascia. 

    Conservative Massage Treatment

    Conservative treatment, such as physiotherapy, aims to reduce local inflammation, give a personalised programme of exercises and stretches to follow and address any biomechanical problems. The plantar fascia is continuous with the gastrocnemius and soleus muscles of the calf. Therefore relief may be provided by massage to these muscles and reducing the strain on the plantar fascia. An effective self-treatment technique can ease out tension in the calf using a massage stick. Massage under the foot if pain allows which may help reduce symptoms.  While the plantar fascia is still painful it may be treated with ice packs (never apply ice directly to the skin) and anti-inflammatory drugs prescribed by a doctor. Stretching and strengthening exercises should be progressed as pain allows.

    Can stretching cure plantar fasciitis?

    Stretching the plantar fascia (by pulling the toes towards the shin) is effective in encouraging the tissue to regain its normal alignment. This helps the healing process and can relieve the symptoms of Plantar Fasciitis. Prolonged stretching of the plantar fascia can be achieved using a night splint which is worn during sleep. Some research indicates that night splinting can significantly reduce plantar fasciitis symptoms in over 80% of cases – particularly pain on the first few steps after waking up each morning. The best conservative approach is thought to be a combination of both stretching and strengthening.

    Does KT Tape work for plantar fasciitis?

    Taping has been shown to be an effective treatment for plantar fasciitis for some. The kinesiology tape supports the Plantar Fascia and removes some of the strain on the achilles tendon and plantar fascia that can aggravate the condition. 

    Invasive Treatments: Cortisone Injections & Surgery

    Plantar fasciitis settles with conservative treatment in 95% of cases.  For the more chronic cases there have been reported good results from extracorporeal shock wave therapy (ECSWT)

    However, in severe cases where heel pain is affecting normal walking then an injection with a mixture of corticosteroid and local anaesthetic is sometimes helpful. Following this injection, the patient is required to rest for a few days, then normal activities can be resumed gradually.

    How do you know if you need surgery for plantar fasciitis?

    In persistent cases of plantar fasciitis, that fail to respond to 6 months of conservative treatment, then surgery can be considered. In the past, surgical techniques have included removal of bony spurs from the heel bone and release of the plantar fascia from the heel bone itself, but the results were inconsistent. These invasive surgeries often caused later problems such as nerve damage and changes to the mechanics of the foot.

    If ongoing problems and no response to conservative management then a referral to an orthopaedic or podiatric surgeon is recommended.

    Ultrasound Guided Needle Fasciotomy: An Alternative to Invasive Surgery

    A modern treatment approach for plantar fasciitis is an ultrasound guided needle fasciotomy. This is a minimally invasive procedure where a needle is inserted into the plantar fascia and moved back and forwards to disrupt the fibrous tissue that proliferates as a result of the chronic inflammation. Because a needle is used instead of a scalpel, and because the whole procedure is observed using an ultrasound scanner, then there is far less danger of surgical complications. By disrupting the tight fibrous tissue the strain on the plantar fascia is relieved and healing can take place.

    How to Prevent Plantar Fasciitis

    • Support the inner arch with a foot support to limit excess pronation
    • Wear shoes that provide adequate support for the foot. Unsuitable footwear can increase strain of the plantar fascia and lead to the development of inflammation.
    • Insoles that support the arch on the inner side of the foot can be helpful for limiting excessive pronation and relieving stress on the plantar fascia and achilles tendon.
    • Self massage to the calf muscles (gastrocnemius and soleus) using a massage stick, strengthening exercises for the arch and stretching are all effective ways of easing the symptoms of plantar fasciitis at home.

    How to Prevent Plantar Fasciitis 

    • Monitor weight
    • Watch loading and increase activity levels steadily
    • Support the inner arch with a foot support to limit excess pronation
    • Wear shoes that provide adequate support for the foot. Unsuitable footwear can increase strain of the plantar fascia and lead to the development of inflammation.
    • Insoles that support the arch on the inner side of the foot can be helpful for limiting excessive pronation and relieving stress on the plantar fascia and achilles tendon.
    • Self massage to the calf muscles (gastrocnemius and soleus) using a massage stick, strengthening exercises for the arch and stretching are all effective ways of easing the symptoms of plantar fasciitis at home.

     

    Leave a comment