Plantar Fasciitis (now termed fasciopathy, and referred to as PF) is all too common, and we see a lot of this in clinic.
It has a number of causes, but the good news is there’s quite a lot you can do to help yourself and the sooner you do something, the better. However, if you ignore it, or its causes, it can trouble you for a very long time.
The plantar fascia is a thick shock absorbing tissue that sits on the undersurface of your foot and runs from your heel bone to your toes. Plantar fasciitis occurs when any part of this structure becomes irritated or inflamed, usually due to overuse or repeated microtrauma causing damage and degeneration within the tissues and is common in those with poor lower limb biomechanics. We used to think that the pain was down to a bone spur on the heel, but we know now that this is not always the case.
What are the symptoms of Plantar Fasciitis?
The most common sign is heel pain – just at the front of the fleshy part of your heel on the undersurface. The pain can also extend anywhere along the plantar fascia itself under the arch of your foot. The classic report we hear is of pain first thing in the morning, when you take your first steps after being in bed or after periods of rest, for example having been sitting at your desk for a few hours. The plantar fascia itself is usually very tender to palpate (or touch) when it is in this state, and the pain is often worsened by walking around barefoot.
What are the causes of Plantar Fasciopathy?
As with any injury, there is rarely one cause. These cases are multi-factoral and by addressing the problem from many angles, you have a much better chance of recovery. We must address the underlying factors and not just try and make the pain go away – that is how you will get long term resolution from this and any other biomechanical issue.
There has been some research to show that poor calf/Achilles flexibility and an associated lack of range of movement within the ankle joint are linked to plantar fasciitis. As with the familiar song from childhood ‘the foot bone’s connected to the leg bone’ we need to remember that everything is connected and the plantar fascia is in fact a direct continuation of the Achilles tendon which is a continuation of the calf muscle and this is why one will affect the other.
Changes in exercise regime, sporting surfaces, a change in weight, excessive weight, pregnancy, footwear with inadequate shock absorption, as well as poor arch support (such as with flip flops) can also be linked to plantar fasciopathy.
Shoes with inadequate support or shock absorption can irritate plantar fasciopathy if worn during your working hours for 8-10 hours per day and also the same goes for running shoes worn for comparatively less time. Ladies who wear heels all day and then run during evenings and weekends may suffer more. Sufferers also report that going barefoot increases symptoms .
How is Plantar Fasciopathy diagnosed?
A working diagnosis is made from the signs and symptoms you present with as well as your case history and the onset of pain. An x-ray will tell you if you have a bone spur but this won’t show any soft tissue damage or degeneration. Our imaging of choice is diagnostic ultrasound but this is not usually necessary unless your symptoms are not settling with conservative treatment and management.
How is Plantar Fasciopathy Treated?
You may be advised to rest from certain activities that aggravate your symptoms but we will do our best to keep you active and modify your activity to maintain your health and fitness.
We will agree a treatment program with you which may include SHOCKWAVE THERAPY and you will be given supporting advice and exercises. It is important that you take this advice and undertake your rehabilitation exercises as this is very much part of the process and means that you are helping to reduce the risk of the symptoms coming back in the future.
We look at what you spend your days doing, and what your wear on your feet during this time. We might recommend a basic over the counter orthotic to support your rear foot motion and provide some support for your foot arches. We may strap your affected foot to provide a 'sling' around the plantar fascia to allow it to rest and heal.
Often we will perform a ‘gaitscan’, putting you on a computerised forceplate to show us exactly what is going wrong in your gait cycle and foot mechanics. This gives us more information about how to treat and rehabilitate you, and in some cases we will make custom, prescription orthotics which you will wear in your running shoes, or work shoes, or both.
It can take a while for PF to settle even if you are religious about your treatment and management approach to it. This is because our bodies have a cyclical regeneration/repair process which takes around 12 weeks and so you should start to see some real improvement after this time, but it can take longer – up to 9 months so you must be patient. That said, our patients see improvements from their very first visit.