When plantar fasciitis is so bad I can’t walk

Treatment of plantar fasciitis should consist of physiotherapy and podiatry.

What is plantar fasciitis?

The plantar fascia is a strong band between the heel and forefoot and helps support the ankle and foot arch. Plantar fascia injuries are common in active elite athletes and weekend warriors. In general, swelling of the plantar fascia, also known as plantar fasciitis or heel spur, usually occurs at the heel end.

What are the typical features?

Generally, pain is often throbbing or burning at the inside of the heel. Usually, the pain appears gradually onset over weeks to months, although it occasionally presents suddenly. The pain worsens in the morning or at the beginning of activity but warms up. Sometimes, plantar fasciitis can be so bad that you can’t walk.

Heel pain that is not inflammatory could be due to another cause. For example, burning or electric pain might be due to nerve compression at the foot or from the spine. Examples include tarsal tunnel syndrome or Baxter’s nerve compression. Pain at night could be consistent with a calcaneal stress fracture

What is a heel spur? 

A heel spur is a calcification at the end of the heel bone. Although a heel spur is common in people with plantar fasciitis, it is not the cause of plantar fascia pain. Other causes of a heel spur include osteoarthritis and inflammatory arthritis.

How do we diagnose plantar fasciitis?

Usually, we diagnose plantar fasciitis by a clinical assessment. Firstly, a history of typical pain combined with an examination of tenderness at the site of plantar fascia swelling are classical features. In addition, it is essential to detect factors that increase the risk of this injury, including training errors and restrictions in the lower back, pelvis, or lower limb.

Generally, imaging assists in confirming the diagnosis. Ultrasound helps detect typical changes in swelling and thickening of the plantar fascia. Ultrasound excludes conditions that mimic plantar fasciitis, such as plantar fibroma. In addition, we use MRI if we suspect other conditions, such as stress fractures or bone cysts in the heel or Baxter’s nerve entrapment. Not all heel pain is due to plantar fasciitis and may need different treatment.

What is the treatment of plantar fasciitis?

When plantar fasciitis is so bad you can’t walk, we suggest you consider the following steps:

  • Reduce your step count or impact activity such as running
  • Apply ice to the affected area for 10-15 minutes 3-4x/day.
  • Massage the foot using a golf or tennis ball.
  • Take a short course of anti-inflammatories such as ibuprofen.

We suggest seeing a health practitioner to help stretch the plantar fascia and perform foot-strengthening exercises to expedite the resolution of acute plantar fascia pain. Also, a simple insole for shoes is helpful to support the arch.

Generally, no treatment is required for the heel spur as it doesn’t cause pain.

What do you do if these simple measures fail?

Typically, seeing an expert for imaging and confirmation of the diagnosis for stubborn cases of plantar fasciitis is essential.

A discussion about other options tailored to your particular needs will help.

Generally, shockwave therapy is an effective treatment. The procedure works by sending a mechanical sound wave to the affected tissue. These sound waves stimulate the body’s healing response. Often,3-5 sessions at weekly intervals are required. A recent study found a significant effect of shockwave therapy on short and long-term pain from plantar fasciitis.

In some problematic cases, injections for plantar fasciitis are performed. There is evidence that ultrasound-guided injections work for plantar fasciitis. Moreover, studies on different types of injections show improved pain in the short to medium term. Performing this injection with ultrasound improves accuracy and lowers the risk of complications.

Cortisone injections give short-term relief and are generally recommended for severe pain. However, risks of a cortisone shot for plantar fasciitis include plantar fascia rupture, fat atrophy and persistent pain. Generally, we suggest you avoid cortisone shots due to the risks. 

Platelet-rich plasma injections are an alternative to cortisone injections. Recent evidence suggests that PRP injections provide a better, more prolonged-term effect than cortisone without risks such as rupture or fat atrophy. However, the positive impact of PRP is not immediate and often takes 2-3 months.  

You can find out more information on heel spur injections here.

As heel spurs do not cause pain, they don’t need to be removed.

What about plantar fascia tears?

Sometimes, the plantar fascia tears, causing acute heel pain and swelling. In most cases, we recommend boot immobilisation for about three weeks, followed by physiotherapy and orthotics.

Recent evidence suggests that cortisone injections for plantar fasciitis might increase the risk of progression to a plantar fascia rupture.

Final word from Sportdoctorlondon about plantar fasciitis so bad that you can’t walk 

Generally, most cases of plantar fasciitis will improve with simple treatments such as rest, stretching, and foot strengthening exercises. For stubborn cases, shockwave therapy is beneficial. For challenging cases, a trial of an injection may help. We favour platelet-rich plasma rather than cortisone injections. Heel spurs do not need to be removed.

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.