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 that connects the heel to the forefoot, helping to 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, plantar fasciitis is characterised by throbbing or burning at the inside of the heel. It usually appears gradually over weeks to months, although it occasionally presents suddenly. The pain worsens in the morning or at the beginning of activity but improves as the activity progresses. 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-like pain may be due to nerve compression in the foot or 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. Additionally, it is crucial to identify factors that increase the risk of this injury, including training errors and limitations in the lower back, pelvis, or lower limbs.
Generally, imaging helps confirm 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- 4 times a day.
- Massage the foot using a golf or tennis ball.
- Take a short course of anti-inflammatories such as ibuprofen.
We recommend consulting a healthcare practitioner to help stretch the plantar fascia and perform foot-strengthening exercises to expedite the resolution of acute plantar fascia pain. Additionally, a simple shoe insole can help support the arch.
Generally, no treatment is required for a heel spur, as it typically doesn’t cause pain.
What do you do if these simple measures fail?
Typically, it is essential to consult an expert for imaging and confirmation of the diagnosis in cases of stubborn plantar fasciitis.
A discussion about other options tailored to your specific needs will be helpful.
Generally, shockwave therapy is an effective treatment. The procedure works by sending a mechanical sound wave to the affected tissue, stimulating the body’s healing response. Often, three to five sessions at weekly intervals are required. A recent study found a significant effect of shockwave therapy on both short—term and long-term pain from plantar fasciitis.
In some cases, plantar fasciitis injections may be necessary. There is evidence that ultrasound-guided injections are effective for treating plantar fasciitis. Moreover, studies on various types of injections have shown improved pain relief 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, the risks of a cortisone shot for plantar fasciitis include rupture of the plantar fascia, fat atrophy, and persistent pain. Typically, we recommend avoiding cortisone shots due to these risks.
Platelet-rich plasma injections are an alternative to cortisone injections. Recent evidence suggests that PRP injections offer a more effective and prolonged benefit than cortisone, without the risks associated with cortisone, 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 a beneficial option. For challenging cases, a trial injection may be helpful. We prefer platelet-rich plasma over cortisone injections. Heel spurs do not typically require removal.
