Plantar fasciitis (spur heel) is a painful problem affecting the heel and sole of the foot. It is an inflammatory process of the plantar fascia and is associated with Heel Spur (or Spur Heel) as pain from the plantar fascia is often caused by the calcification from a developing spur.

Longstanding cases of plantar fasciitis often demonstrate more degenerative changes to the connective tissue than inflammatory changes, in which case they are termed plantar fasciosis. The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes.

Plantar Fasciitis heel pain is often associated with long periods of weight bearing.  It can also be associated with being overweight or inadequate footwear. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is increased probability ofknee pains, especially among runners. Often linked to a change in footwear or playing surface.

Diagnosis

The diagnosis of plantar fasciitis is usually made by full clinical examination alone. The clinical examination will usually include checking your feet and watching you stand and walk (your gait pattern). Your Physiotherapist’s examination will take under consideration a patient medical history, physical activity, foot pain symptoms and more. In some cases it may be necessary  to use imaging studies like radiographs, diagnostic ultrasound or MRI. Your Physiotherapist will guide you through this process if required.

Sometimes imaging can find a heel spur, a small bony calcification, on the calcaneus heel bone, in which case it is usually the plantar fascia, and not the spur itself, which produces the pain.

Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis.

Treatment

There are different approaches to treating Plantar Fasciitis. Our Physiotherapists regularly treat people with this problem with great success and they will devise the most suitable approach to correcting your problem and returning you to normal activity.

Physiotherapy treatment options include specific stretching techniques, taping techniques, footwear analysis/advice, corrective exercises, massage techniques, Ultrasound Treatment, Shortwave Diathermy. Sometimes ‘over the counter’ orthotic insoles for your shoes may be recommended by your Physiotherapist or referral is made to a recommended Podiatrist. This is usually in cases where more detailed gait analysis is required and specially casted orthotics are the recommended route.

Local injection of corticsteroids often gives temporary or permanent relief, it can be painful, but is usually combined with a local anaesthetic to ensure best possible comfort. Repeated steroid injections may result in rupture of the plantar fascia and are, therefore not recommended  . While this may actually improve pain initially, it has deleterious long-term consequences.

In severe, longstanding cases, surgery is sometimes indicated. If conservative treatment is not deemed suitable your Physiotherapist will arrange onward referral to a suitable Specialist after discussion with yourself.

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