Plantar Fasciitis – What You Need To Know

Planar fasciitis is a medical condition characterised by pain over the sole of the foot, especially after rest and sleep. Plantar fasciitis is caused by inflammation of the plantar fascia over the sole of the foot. The condition is most common between ages of 40 and 60, affecting men and women equally.

Risk factors for development of plantar fasciitis include:

– Stiff and tight calf muscles
– Obesity
– Increase weight bearing activities (overuse)
– Flat feet or high arches
– Increase age
– Change in footwear

Symptoms

Symptoms of plantar fasciitis:

– Sharp heel pain
– Pain on touch
– Pain that is characteristically worse when first getting out of bed or after a long rest
– Pain improved after walking

Even though the symptoms and diagnosis of plantar fasciitis may seem apparent, there are other serious conditions that could present with similar symptoms.

Other conditions that could present with heel pain:

– Nerve compression over the lower back
– Plantar warts
– Gout, rheumatoid arthritis
– Calcaneal stress fracture

Consult an orthopaedic doctor if you show the above symptoms.

Investigations

Plantar fasciitis can be diagnosed clinically without further investigations if the patient’s symptoms and signs are clear. XRays and magnetic resonance imaging (MRI) of the foot may be performed to confirm the diagnosis. Further imaging may sometimes be necessary if the patient has flat feet or high arches. Xrays may show heel spur over the calcaneal. MRI will be able to demonstrate inflammation of the plantar fascia.

Treatment

The treatment for plantar fasciitis should be individualised according to

– patient demographics (age, occupation, sporting activities)
– Severity of symptoms

All patients with plantar fasciitis should be given a course of anti-inflammatory medications (oral and/or plasters). Patients should also modify their lifestyle to avoid aggravating activities eg by reducing weight bearing activities such as running or dancing. They should also use cushioned heel inserts to reduce the pressure and stress over the plantar fascia. Patients should avoid walking bare footed at home by wearing shoe-wear. Patients should also undergo Achilles tendon and plantar fascia stretching physiotherapy. Patients can also stretch the plantar fascia by rolling their foot over a frozen water bottle. Extra-corporeal shock wave therapy is another form of non-invasive treatment. Shockwave therapy has been shown to stimulate healing and reduce inflammation. If symptoms persist after non-invasive treatment, the next option would be steroid injection. Platelet rich plasma (PRP) would be another option for plantar fasciitis treatment. Platelet rich plasma is a form of regenerative medicine using patients’ own blood and nutrients for healing.

For patients with severe symptoms that are not relieved by the non-surgical treatments, the next treatment option would be surgical release of the plantar fascia and/or gastrocnemius. This surgery involves controlled release of the tight calf muscle. The plantar fascia will also be partially release. The surgical release can be performed open or using an endoscope (keyhole surgery). Your orthopaedic surgeon will discuss in detail regarding the pro and con for each option. Open plantar fascia release involves making an incision over foot and cutting part of the plantar fascia. Endoscopic plantar fascia release (keyhole) can be performed by two small incisions over the inside and outside of the foot. The surgery will be performed under general or regional anaesthesia. The surgery will take about 1 hour. You can be discharge on the same day. Your surgeons will review your condition regularly after surgery to make sure your recovery is on track.