The plantar fascia is connective tissue which connects the heel bone at the bottom of the foot, spanning along the foot towards to the toes. It provides stability to the foot which aids the muscles and tendons as the foot moves through the gait cycle. It can be very tender in the early stages of plantar fasciopathy.
The fascia is under a lot of strain due to its function providing foot stability with each step we take. The increase in tissue thickness is very sensitive in the early stages as it has little rest from impact and tension in walking. Age and weight have a large part to play in its development although there are other risks factors.
Common symptoms are pain in the heel on first steps in the morning or after a period of sitting. Pain can exist underneath the heel and into the arch of the foot.
Plantar Fasciitis / Plantar Heel Pain | All about Self Help & Treatment. – YouTube
Managing weight is important therefore a balanced healthy diet is encouraged. This will add high value to your recovery and long-term health.
See our “Healthy Living” section for more information on local healthy weight services
Appy an ice pack covered with a towel for 15-20 mins. Using a frozen water bottle can help offer some initial symptoms relief.
Over the counter painkillers like paracetamol will ease the pain, always follow the instructions on the packet. A short course of ani-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist or GP, especially if you have any underlying health conditions.
Resting of the foot might provide some relief. Often, if the heel is aching in the evening towards the end of the day it is likely bruised. Use heel lifts, cups or insoles and wear trainers to provide further cushioning; avoid barefoot walking/prolonged standing on hard floors at home. If you’re doing exercise, then make adjustments to reduce high impact activity. Although staying active is still encouraged for your health, walking distance might be adjusted or the speed of walking to reduce heel impact.
A heel lift is designed to reduce the pull of the soft tissues that attach to the heel bone. This can also provide some cushioning to the heel itself which can help reduce symptoms. This has been shown to help some patients in recovery. Place this at the base of the heel inside your shoes. These lifts are all doing the same thing but look very different.
Generally, avoiding footwear that aggravates your symptoms is advised. However, we need to be careful about this as sometimes the shoes might not be the aggravator it might simply be the task you’re doing. We advise wearing a practical, cushioned, stable shoe with a 8-10mm heel support, (such as running trainers or walking shoes) avoid flat and unsupportive options. A running trainer/walking shoe is recommended in the recovery of your foot pain and is likely to assist in the symptom reduction phase. Avoiding dress shoes, hard heeled shoes, or backs of shoes that aggravate your symptoms.
These are not routinely recommended as 1st line treatment. In some instances, whereby the patient has failed to recover or there is a lot of pressure on the foot due to its structure. Some insoles will be more cushioned based i.e., with a soft heel lift or some will have more structure i.e. arch support. There is no one-size-fits-all approach, but you access these yourself online.
This can provide pain relief in the acute phase, although can be awkward to apply. A low-dye method or a heel cupping technique are commonly used.
Can be used to try and hold the foot position in the night to attempt to reduce morning pain. Their success is variable.
How to Exercises Toe Motion – YouTube
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Increasing Intrinsic Foot Muscle Strength – Insoles and Orthotics – Healthy Step
If you prefer to stretch your calf muscles whilst seated you can use a towel or a belt to stretch your calf muscle.
You should:
Radial Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment that involves passing high energy pressure waves into affected tissue to increase blood flow and stimulate repair. The body responds to shockwave by increasing the blood circulation and metabolism in the affected area which is thought to accelerate the body’s own healing processes. Evidence shows it may help in the treatment of chronic tendinopathies when used alongside other forms of conservative treatment, such as exercise, weight loss and pain killers.
An injection into the joint might be considered if you have on-going pain and stiffness. There is a risk the steroid can cause the fascia to rupture and steroids also can affect the surrounding soft tissues.
A release of the plantar fascia or gastrocnemius muscle are procedures used in management of chronic cases. Surgery is not an easy decision as may lead to an altered foot position afterwards.
Off-work: There will be a requirement to elevate your foot and rest non weight bearing then semi weight bearing.
Infection: The act of surgery is invasive which is also a risk to infection. In some cases, this can delay healing and will require antibiotic treatment.
Delayed Healing: If the blood supply is not so good or you have poor health this might affect healing time. Smoking has been shown to affect healing to bones and soft tissues.
Blood Clots: A small risk of developing a blood clot after foot surgery. Following the pre and post operative advice will help reduce this risk.
Scarring: Any type of surgery will leave a scar. Occasionally this can cause pain and irritation. If this happens, please discuss this with your consultant.
Swelling and Stiffness: The foot can swell as a response to surgery and as part of the healing process. It can take up to six months for swelling to completely settle in some cases. Although in some cases post-surgery there may be increased stiffness in the foot.
Numbness: Can exist in the surgical site if there has been disruption to a nerve.
Chronic Regional Pain Syndrome: Surgery can sometimes result in a swollen, painful and highly sensitive foot. This can be challenging to manage and often patients will be referred to the pain clinic for support.
Contact your general practice if you need further help and guidance, a referral to local musculoskeletal services is required in some instances, and they can advise on appropriate treatment or pathways suitable to you.
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