Plantar Fasciitis: Foot and Heel Pain

Plantar fasciitis is caused by strain to the plantar fascia under the foot, which could be caused by a degenerative condition or a previous injury.

It is more likely to affect women and those aged 40 – 60. Other risk factors include:

• Obesity
• Those with flat feet or high arches
• Those who have tight Achilles tendons
• Frequent use of high heels
• Long hours of standing daily
• Using shoes with poor support
• Exercising on hard surfaces
• Recent increase in running, walking or standing

The most common symptom of plantar fasciitis is ‘first step pain’, which is pain that occurs when you take your first steps after getting up in the morning, or when you first start walking after resting. The pain may subside during exercise but recur after a period of rest and you could experience difficulty raising your toes off the floor. There may also be swelling of the foot.

To confirm if you have plantar fasciitis, your doctor will examine your feet and ask about your symptoms. Tests may be advised, such as an X-ray or MRI so your doctor can be certain that the pain is not caused by a fracture or arthritis.

If you experience persistent pain with little or no relief from rest, it’s best to speak to your doctor.

There are several home remedies and non-surgical options that can help to relieve the pain. These include:

• Rest
• Stop any activity that makes the pain worse, such as activities that include running or jumping
• Ice the heel
• Use corrective aids such as shoes with extra support or orthotic inserts to provide more cushioning and/or arch support
• Wear night splints to stretch your calf and foot while sleeping
• Medication to relieve pain and inflammation, under your doctor’s supervision

Physical therapy is also helpful to stretch the plantar fascia and Achilles tendon, and strengthen leg muscles to make the ankle and heel more stable.

These interventions usually take up to 10 months for any improvement. If they do not offer sufficient relief, your doctor may recommend cortisone injections to ease the inflammation.

Surgery is also an option if other forms of treatment are unsuccessful, or if the pain is severe and persistent for more than 6 months. Your doctor may recommend one of the following:

• Plantar fascia release, which involves the partial detachment of the plantar fascia from the heel bone. This reduces tension and relieves pain, but it also weakens the arch of the foot and may limit its full function.
• Gastrocnemius recession, if you have difficulty flexing your feet even after stretching. This procedure lengthens the calf muscle, increases ankle motion and relieves stress on the plantar fascia.

As any form of surgery comes with risks, it is advisable to attempt non-surgical options first. Consult an orthopaedic surgeon to determine the treatment method most suitable for you.

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Leaving plantar fasciitis untreated may result in chronic heel pain that affects your regular activities.

If you have plantar fasciitis, you should avoid physical activity during an acute injury. If you have chronic heel pain, you can do light exercises while wearing supportive footwear. Stretching your calf muscles daily helps if you wear high heels.