Plantar Fasciitis – A Pain in the Heel

Heel pain is one of the most common problems that podiatrists treat.  The most common cause of heel pain in adults is plantar fasciitis, essentially an injury to a large supportive ligament which attaches onto the heel bone.  Plantar fasciitis is most commonly seen in the active adult population, either as an occupational or sporting injury.  It is characterized by intense pain under the heel when the patient stands up after resting and will generally improve a little as they take their first few steps.  Prolonged standing and walking will make symptoms worse.

X-rays may reveal a bony outgrowth, or ‘spur’.  The spur very rarely causes the pain and rarely requires surgical removal.  In fact, approximately 70% of the adult population has undetected spurs which never bother them.

Plantar fasciitis may be caused by many factors.  Most of these factors are mechanical and include:

  • an increase in walking or running;
  • an increase in weight;
  • an increase in sporting activities which require rapid accelerative movements;
  • prolonged standing, especially on hard flat surfaces;
  • biomechanical abnormalities in the shape or function of the foot.

Sometimes plantar fasciitis accompanies systemic disorders such as Ross River Fever or rheumatoid arthritis.  Although these cases are relatively rare, your podiatrist is trained to look for other signs or symptoms that may be associated with these disorders.

Treatment of plantar fasciitis is simple and effective in most cases.  Initially, relief from symptoms can be achieved by reducing the pulling or tensile stress on the plantar fascia with supportive strapping.  Anti-inflammatory medication and ice may be useful in the early stage of treatment.  Addressing the mechanical causes by a change to footwear that is supportive and well cushioned often helps.  If there is a problem in the mechanical function of the foot supports (orthoses), often provide long-term relief from symptoms when walking.  Rehabilitative stretching exercises are also very useful in the long-term treatment of plantar fasciitis.

Although plantar fasciitis may be debilitatingly painful, 95% of cases will respond well to treatment.  However, complete resolution may take three to six months.  Surgery is rarely required and is reserved for cases that haven’t responded to conservative treatment after six months or more. A new treatment (lithotripsy or extra-corporeal shockwave therapy) has also been shown to be effective in the rare cases that do not respond to the treatments outlined above.