The Heel Pain Expert

FAQs

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1. What is plantar fasciitis?

2. What causes plantar fasciitis?

3. What are the symptoms of plantar fasciitis?

4. How is plantar fasciitis diagnosed?

5. Why did I get plantar fasciitis?

6. Is plantar fasciitis treatable?

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

8. What causes treatment to fail?

9. How do I prevent the pain recurring?

10. Custom orthotics or prefab orthotics?

11. What does massage rolling the plantar fascia do?

12. Do night splints work for plantar fasciitis?

13. Do steroid injections work for plantar fasciitis?

14. Does plantar fasciitis cause knee pain?

15. Exercises makes my plantar fasciitis worse. What can I do?

16. Are loading exercises helpful for plantar fasciitis?

1. What is plantar fasciitis?

Plantar fasciitis is a common painful foot condition located mostly at the heel. Although originally thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the plantar fascia leading to thickening of the fibre and may be more accurately termed plantar fasciosis. Plantar means the 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. It is an overuse injury where the plantar fascia becomes strained due to levels of stress that exceed how much the plantar fascia can tolerate. The level of stress the plantar fascia can tolerate varies from person to person.  Plantar fasciitis is the most common cause of heel pain affecting up to 10% of the population. Approximately 90% of heel pain is caused by plantar fasciitis. 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. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the plantar fascia.  

 

2. What causes plantar fasciitis?

 

The cause of plantar fasciitis is multi-factorial meaning that it is caused by a combination  of individual factors. There is no one single cause of the condition. Proposed causative factors in the medical literature can be split into two types:


Intrinsic factors:

·         feet that roll inwards too much when walking (increased pronation)

·         feet with very low arches (flat feet)

·         feet with very high arches

·         tight Achilles tendons or calf muscles

·         tight hamstrings

·         limited ankle joint flexibility

·         being overweight

 

Extrinsic factors:

·         Occupations that keep you on your feet. Factory workers, teachers, chefs, nurses, cleaners 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.

 

 

3. What are the symptoms of plantar fasciitis?

 

Plantar fasciitis is diagnosed clinically with the classic symptoms of "sharp/stabbing" 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 after a while, but then returns after prolonged standing or walking. Typically pain is noticeable when standing after a long period of rest, this is known as post-static  dyskinesia. 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. 

 

4. 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, along with a clinical assessment by a podiatrist or suitably qualified health professional. Diagnostic imaging such as ultrasound and MRI are not routinely used to confirm a diagnosis but can be helpful  when one is unsure of the diagnosis. Diagnostic imaging is also useful  to rule out differential diagnoses such as radiculopathy (referred back pain), bone oedema (swelling), plantar fascia tear, stress fracture, inflammatory disorders etc.  

 

5. 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 the amount of stress placed on the plantar fascia exceeds the amount it can tolerate it becomes damaged causing the connective tissue that forms the arch of the foot to become thickened and degenerative. The reason one may have placed too much stress on their plantar fascia varies greatly from person to person. For some, it may be a combination of tight calf muscles and feet that  pronate (roll in). For others, it may be standing for long periods in unsuitable footwear. All of these individual factors contribute to the loading stress on the plantar fascia.   

 

6. Is plantar fasciitis treatable?

 

Absolutely! But no single treatment works best for everyone with plantar fasciitis. The most important thing is to identify and eliminate the causative factor(s), which differs from person to person. Seeing a podiatrist should be your first port of call. There are many treatment options for plantar fasciitis. Please see the treatments page for further details in specific treatment options.

 

 

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

 

This is a tough question as there are many factors that can influence one's healing such as their overall medical health, certain medical conditions are known to delay one's capacity to heal from injury such as diabetes, immune deficiencies, poor blood supply etc.   Plantar fasciitis most often occurs because of repetitive micro-trauma injuries that have happened over time. The length of time you have had the condition also influences how well it will respond to treatment. What we know is that chronic conditions (over 6 months) are more difficult to heal and less respondent to conventional treatment. Therefore the quicker you receive treatment the better chance you have in curing the problem.

 

8. What causes treatment to fail?

 

Nonsurgical treatments almost always improve the pain. It is commonly reported that 90% of cases will get better from nonsurgical treatment. 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 inappropriate treatment recommended, and poor patient compliance i.e. not wearing appropriate footwear or not performing prescribed treatments correctly. Treatment may also fail in chronic plantar fasciitis (having the condition for over 6 months). In chronic cases, the plantar fascia may become very degenerative with a build up of scar tissue. This makes the condition more difficult to treat and less responsive to conventional  treatment. In chronic cases, one may benefit from treatments aiming to promote and restart the healing cascade such as  extra-corporeal shockwave therapy. We will cover this treatment option in more detail in another article. 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.

 

 

9. 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 or as often as you start to notice any tightening of your muscles. Maintaining the improved flexibility reduces your chances of going 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.

10. Custom made orthotics or prefab orthotics?

Both types of orthotics can be effective for plantar fasciits, however custom made orthotics are deesigned specifically for the individual patient characteristics such as foot shape, arch height, body weight, material stiffness of the orthotics, and prescription control. These features increase the likelihood that the orthotics will be effective. On the other hand, prefab orthotics are ready made meaning that the design and shape are predetermined and not specific to the individuals needs. Although prefab orthotics often provide suport for the arch of the foot which helps reduce plantar fascia strain, the results are less consistent and reliable when compared to custom made orthotics. Prefab orthotics are considerably cheaper than custom made orthotics and for some people a prefab orthotic may be adequate, however it is largely a guessing game when choosing the prefab option. I only provide custom made orthotics for my patients as I believe in offering a gold standard level of service.

 

11. What does massage rolling the plantar fascia do?

Massaging the plantar fascia with a foam foller of similar product is one of the most common recommended treatments for plantar fasciitis but what does it actually do? The short answer is we don't know exactly but it is often helpful for reducing pain severity. Massaging the plantar fascia appears to provide a therapeutic affect resulting in pain relief. This may be due to the mechanical stimulation of the plantar fascia tissue causing a change in the pain receptor messages to the brain. Not everyone will experience pain relief but it is worth trying if you're struggling with pain  management. A limitation of this treatment is that it does not address the cause of the problem and is therefore not effective as a stand alone treatment.

12. Do night splints work for plantar fasciitis?

Night splints are very effective and underrated as a treatment option for plantar fasciitis. The are very helpful for reducing pain first thing in the morning when taking your first few steps getting out of bed. If you're interesting in learning how they work then check out the video  below.

13. Do steroid injections work for plantar fasciitis?

Steroid injections are one of the most common treatment options for plantar fasciitis. Approximatley 60-70% of patients will have good pain relief from steroid injection for up to 2-3 months. Unfortunately most patients will experience recurrence of their pain beyond this period. This often leads people feeling frustrated and fed up as they feel like they are back to square one. Steroid injections are generally safe when patients are carefully selected by a qualified clinician, however they do come with certain risks such as plantar fascia rupture, thinning of the plantar fat pad which can have long term complications. For more information check out the video below.

14. Does plantar fasciitis cause knee pain?

Plantar fasciitis does not directly cause knee pain as the plantar fascia is a structure on the bottom of the heel and sole of the foot, however plantar fasciitis can indirectly cause knee pain. This can occur due to compensation. Many plantar fasciitis sufferers develop a compensatory way of walking in an attempt to offload the painful heel. If compensation continues long enough it increases the likelihood of  developing secondary issues with knee pain being of one of the most common.

15. Exercise makes my plantar fasciitis worse. What can I do?

Some forms of exercise such as walking long distances, hiking, running and aerobics will exacerbate plantar fasciitis due to increased loading stress on the plantar fascia. This can make exercising limiting, however there are alternative exercises which are more friendly on the plantar fascia and less likely to exacerbate it. Check out the video below for advice on alteranative exercises. 

16. Are loading exercises helpful for plantar fasciitis?

 

Loading exercises can be helpful for  plantar fasciitis, however they can also make it worse if not performed correctly and at the right stage. One of the benefits of loading exercises is that this may lead to an increase in load tolerance, meaning that the plantar fascia is able to tolerate more loading stress, allowing you to increase your activity levels without re-injuring the plantar fascia. On the other hand, loading exercises can make it worse as creating overload of the plantar fascia tissue, leading to further strain and increased pain. To help minimise oveloading, I have produced a plantar fasciitis rehab programme which you can download for free here.  To learn more about loading exercises check out the video below.