Plantar Fasciitis

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 arch of the ankle and foot. Injury to the plantar fascia is common in active elite athletes to 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. Often, pain is gradual onset over weeks to months although occasionally presents suddenly. Typically, pain is worse in the morning or at the beginning of an activity but tends to warm up.

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 important 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 is useful to detect typical changes of swelling and thickening of the plantar fascia. Ultrasound also excludes other 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. In summary, not all heel pain is due to plantar fasciitis and may need different treatment.

What is the treatment?

All in all, most cases improve with simple treatments of rest from running, stretching of the plantar fascia, and foot strengthening exercises. In addition, rolling the plantar fascia with a tennis or golf ball may help. Also, a simple insole for shoes is useful to support the arch.

What do you do if these simple measures fail?

Typically, for stubborn cases, it is important to see an expert for imaging and confirmation of the diagnosis.  Referral to a physiotherapist for exercises may be useful. Also, a podiatrist can help with shoes and insoles.

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.

In some difficult 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 an improvement in pain in the short to medium term.  Performing this injection with ultrasound improves accuracy and lowers the risk of complications.  You can find out more information on heel spur injections here.

Final word from Sportdoctorlondon

Generally, most cases of heel spur will improve with simple treatments such as rest, stretching, and foot strengthening exercises. For cases that are stubborn, shockwave therapy is useful. For challenging cases, a trial of an injection may help.

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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