Plantar Fasciitis

What is Plantar Fasciitis?

Plantar Fasciitis is the inflammation of your plantar fascia. Your plantar fascia is a strong band of tissue (like a ligament) that stretches from your heel to your middle foot bones. It supports the arch of your foot and also acts as a shock absorber in your foot. Patients report a stabbing sensation when they take their first steps in the morning. Plantar Fasciitis is one of the most common causes of heel pain and tends to be more common in runners.

What causes Plantar Fasciitis?

Abnormal forces on the foot cause plantar Fasciitis. Contributing factors are obesity, weight gain, jobs that require a lot of walking or standing on hard surfaces, badly worn shoes with little support, and inactivity.

As a result of these forces, with every step the Plantar Fascia (band of tissue under the foot) is being stretched, resulting in inflammation, irritation and pain at the attachment of the fascia into the heel bone. In some cases the pain is felt under the foot, in the arch.

  • Injury of the plantar ligament.
  • Excessive flattening of the arch on weight bearing.
  • Tight plantar fascia.
  • Over-pronation of the foot (a complex motion including outward rotation of the   heel and inward rotation of the ankle).
  • Excessive load on the foot from increased body weight.
  • Arthritic changes to the big toe which alter the function of the plantar fascia.
  • Having a very high rigid arch profile of the foot.
  • Underlying medical conditions such certain types of arthritis or diabetes.
  • Plantar Fasciitis is most common in middle-aged overweight adults.

What can I do to help?

Most people can recover from Plantar Fasciitis with rest, icing the painful area, stretches and taking NSAID’s to relieve the pain and reduce the inflammation.

What will happen if untreated?

If you ignore your symptoms you are at risk of developing chronic heel pain. Patients who experience long term foot pain tend to alter their gait to reduce the pressure on the affected area. In the long term this can cause to problems with the rest of the foot, the knees, the hips and the back.

What are the treatment options?

If treated early (i.e. within 3-4 months of the onset of heel pain) Plantar Fasciitis can be treated effectively by wearing orthotic insoles. Orthotics can correct over-pronation and support the arch. This will help release the tension on the plantar fascia, thus treating the cause of Plantar Fasciitis.

For patients experiencing recurrent or chronic plantar fasciitis, other treatments such as Steroid Injections, Shockwave Therapy, PRP Injections and Cryosurgery should be considered.

I have heard Plantar Fasciitis referred to as Plantar Fasciosis? Why do people called it Plantar Fasciosis?

Well it should definitely be plantar fasciosis and here’s why…

Generally speaking any medical term ending in “itis” refers to acute inflammation, a common example of this type of “itis” is Achilles tendinitis. True Achilles tendinitis is a sudden onset inflammatory response to a new injury.  On the other-hand any medical condition ending “osis” refers to a chronic degenerative process, a common example of this is the Achilles tendinosis, where over a longer period, the Achilles becomes thickened tight, and prone to suffering more damage or even snapping.

Broadly speaking when structures such as tendons and ligaments or fascia degenerate or suffer “osis” they become painful, thickened, swollen. They also tend to be less able to perform their normal function and this is exactly what we see with so-called plantar fasciitis.

The vast majority of people diagnosed with so-called plantar fasciitis will have been suffering for many months. By this time, they actually have no signs of acute inflammation of the fascia but instead they have developed chronic degenerative changes, such as thickening, loss of function and of course the dreaded pain felt first thing in the morning and throughout the day.

This better understanding that has allowed us to develop treatments that actually reverse plantar fasciosis. At The Barn Clinic treatment centres we offer restorative treatments in the form of Shockwave, Platelet Rich Plasma (PRP) and Cryotherapy that actually encourage the fascia to repair and rejuvenate.

 

 

The image above is a specialist type of scan called elastography. Elastography studies give a quick visual representation of how hard or soft tissue is. A healthy plantar fascia should be relatively hard (blue), however as the plantar fascia degenerates it becomes thickened and soft (green) or very soft (red). The image above is showing a distinct area of soft tissue within the plantar fascia (green) this is the focal point of this patient’s heel pain.

One of the main benefits of regenerative treatments such as Cryosurgery and PRP is that both treatments seem to help the plantar fascia to recover to its former level of stiffness and return to healthy blue on imaging.

The Barn Clinic is arguably one of the leading heel pain treatment centres in the UK and has such has been utilising ultrasound imaging for over 10 years and is only one of a handful facilities UK wide to offer elastography screening to all plantar fasciitis / fasciosis patients.