What is plantar fasciitis?

Plantar fasciitis is a common painful foot condition located at the heel. Although originally thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the plantar fascia, and may be more accurately termed plantar fasciosis (Lemont et al 2003).

Plantar means bottom of the foot, and fascia is the fibrous tissues that connect the heel bone (calcaneus) to the heads of the metatarsal bones found at the base of your toes.

How do I prevent the pain recurring?

One of the most important things is to maintain your improved flexibility since muscular tightness is one of the leading causes of plantar fasciitis.

This can be achieved by performing stretching exercises once every few days so that you don’t go back to square one.

It is equally important to wear appropriate shoes. This does not mean you have to spend all of the time in supportive footwear.It simply means that spending all of your time in bad footwear will increase the likelihood of the condition recurring.

What causes treatment to fail?

Nonsurgical treatments almost always improve the pain. If the underlying causes of plantar fasciitis are properly addressed patients usually respond very well to treatment.

Reasons for treatment failing are most commonly due to poor patient compliance i.e. not wearing appropriate footwear or not performing prescribed treatments correctly. Another cause for treatment to fail is misdiagnosis where the cause of the pain is in fact not plantar fasciitis but instead a different type of heel pain.

How long will it take for the pain to go away?

Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year.

Stay with your treatment. If you don’t, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.

Is it treatable?

Of course!  But no single treatment works best for everyone with plantar fasciitis. Fortunately, there are many things you can try to help your foot get better:

• A short period of rest – cut back on activities that make the pain worse
• Ice treatment to reduce swelling
• Massage
• Wearing a night splint
• Specifically prescribed stretching programme
• Wearing appropriate shoes.
• Wearing functional foot orthoses (insoles)

What causes it?

The cause of plantar fasciitis in multifactorial meaning that it is caused by a number of individual factors. These can be split into two types:
Intrinsic factors include:

• feet that roll inwards too much when walking (excessive pronation),
• feet with excessively low arches (flat feet)
• feet with excessively high arches
• tight Achilles tendons or calf muscles
• limited ankle joint flexibility
• being overweight

• Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
• Improper shoes – shoes that are not supportive or worn out.

Why did I get plantar fasciitis?

Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot.

It is also one of the major transmitters of weight across the foot as you walk or run.

Therefore, the stress placed on this tissue is tremendous.
When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)–these abnormalities cause plantar fasciitis and can make normal activities quite painful.

How is Plantar Fasciitis diagnosed?

The diagnosis of plantar fasciitis is usually made by a patient history that matches the classical symptoms of plantar fasciitis (see what are the symptoms?), along with a clinical assessment by a podiatrist.

What are the symptoms of Plantar Fasciitis?

Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot as this is where the plantar fascia attaches to the heel bone.

Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking.

The pain is often described as a sharp, stabbing pain and can feel like walking on a marble. In some cases pain may also extend along the sole of the foot where the plantar fascia continues to attach to the metatarsal heads.

Who does Plantar Fasciitis affect?

Plantar fasciitis is the most common cause of heel pain (Singh et al 1997), affecting up to 10% of the population.

It is most often seen in middle-aged men and women (between the ages 40-60), but can be found in all age groups and is also common in the athletic population (Rome et al 2001).

In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.

Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis.  BMJ 1997;315(7101):172-175

Lemont H, Ammirati KM, Usen N. Plantar fasciitis. A degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93(3):234-237.

Rome K, Howe T, Haslock I. Risk factors associated with the development of plantar heel pain in athletes. The Foot 2001;11(3):119-125.