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Plantar fasciitis

We share useful information about plantar fasciitis, which causes pain on the bottom of your foot.

Lady-rubbing-her-foot
Experiencing pain on the bottom of your foot and around your heel and arch? You could have plantar fasciitis – but what is it?

The condition is characterised by pain that worsens when you walk after sleeping or resting. Pain associated with plantar fasciitis may ease during exercise, only to return after resting. You may also find it is difficult to lift your toes off the floor with this condition.

Many people with plantar fasciitis can ease the pain themselves at home, with GPs often suggesting several things you can try. This may include:

  • Resting and raising your foot onto a stool or a chair, when possible
  • Using an ice pack (or a bag of frozen vegetables) wrapped in a towel on the painful area. Try this for up to 20 minutes at a time, every two to three hours
  • Using insoles or heel pads in your shoes, or wearing shoes that have cushioned heels and good arch support
  • Trying exercises which do not put pressure on your feet, including swimming. Gentle stretching exercises may also help
  • Losing weight if you are overweight
  • Taking painkillers like paracetamol and Ibuprofen
  • Avoiding standing for long periods of time
  • Avoiding wearing high heels, tight, pointy shoes, flip-flops or backless slippers. You should also avoid walking barefoot on hard surfaces.

Your pharmacist should also be able to help if you are suffering from plantar fasciitis. You can ask them about the best painkiller to take, when and if you should see your GP, and the recommended types of insoles and/or pads to wear in your shoes.

If you suspect you have plantar fasciitis, you might be wondering what caused it. In short, it’s due to straining the part of your foot that connects your heel to your toes.

This is called the plantar fascia.

If you have started exercising on hard surfaces or if you exercise with a tight calf or heel, you may also be more likely to get plantar fasciitis, as are people who overstretch the sole of their foot while exercising.

Recently started doing more walking, running or standing up? Or perhaps you have been wearing shoes with poor cushioning or support, or you are very overweight?

These are also possible causes of the condition. Professor Anand Pillai, Consultant Orthopaedic Foot and Ankle Surgeon at Circle Health Group’s The Highfield Hospital and the Alexandra Hospital, both located in the north of the country, regularly sees patients with plantar fasciitis.

Pain around the foot isn’t always plantar fasciitis. He confirms that it can be due to pain from the Achilles tendon and stress factors (such as overuse, exercise, or elderly osteoarthritis), or as a result of back pain (such as sciatica).

The above are the common conditions our consultants will aim to rule out, including diabetes, with diabetic patients being more prone to plantar fasciitis. “Most adults will get plantar fasciitis at some point in their lifetime,” says Anand.

“Individuals who are on their feet more often will be more prone to getting the condition. It is also more common in people who do a lot of impact activities, such as people who do a lot of running, sportspeople, and those in occupations such as waiters, postmen, surgeons and nurses.”

People who drive quite a lot may also be more likely to get the condition.

So, you’ve tried a few at-home remedies, such as icing your foot with a bag of frozen vegetables or taking paracetamol. If nothing is working (and you’ve tried at-home remedies for two weeks), you may want to see your GP to see if further treatment is needed.

Make an appointment if you have pain in the bottom of your foot that is severe or is stopping you from doing your normal activities. If the pain is getting worse or keeps returning, you should also call your GP.

Tingling sensation or loss of feeling in your foot? Again, ring your GP for an appointment. Those with diabetes and foot pain should also see their GP; foot problems can be more severe in people with diabetes.

Plantar fasciitis symptoms: should I call 111?

If you suspect your foot-related symptoms point to plantar fasciitis, it’s important to ring your GP, in the first instance, to make an appointment.

Your GP will ask you about your foot-related symptoms and how they are impacting your day-to-day life. He or she may want to examine your foot, too, and discuss any pain relief methods or home remedies you have tried to ease your symptoms.

Your GP will also want to know how long you have experienced foot, heel and arch pain and if you believe anything is responsible for it (such as a new exercise regime).

After looking at your foot – and providing you have tried some pain relief methods for a while before visiting your GP – your doctor may refer you to a foot specialist, if he believes plantar fasciitis is responsible for your pain and/or discomfort.

Consultant Orthopaedic Foot and Ankle Surgeon, Anand Pillai, says it is useful if patients can localise the pain they are experiencing. If for example, they are able to say: “the pain started there or the pain started here”, this is helpful for our Consultant, when he or she is making a diagnosis.

Your Circle Health Consultant may also ask when you experience the pain. “One of the classic features of plantar fasciitis is first-step pain” (i.e. people who struggle to put their foot on the ground, due to the pain they experience when they first wake up in the morning).

“People may find that they hobble for a little while in the morning, but once they are up and walking they may find the pain improves”, says Anand.

“The condition is generally self-limiting.” continues Anand. “It usually improves in time, but it can take 18 months to two years to improve. Generally, it is to do with what you have been doing, so lifestyle changes may be recommended during your consultation.”

“If you are overweight, that can contribute to it [plantar fasciitis]. Sometimes, that’s all you may need to do – lose some weight – because you are offloading the foot.”

“Some people who run a lot may take up swimming or cycling and find that it helps a lot,” says Anand.

Upon examining the foot, your Consultant may find that you have a tight fascia or a tight Achilles tendon. Generally, diagnosis is at clinic and patients don’t need to book in for a follow-up.

MRI scans for plantar fasciitis

If, however, after six months or so the condition has not improved, an MRI scan can be beneficial.

“An MRI scan can show thickening of the fascia and if there is any tearing of the fascia,” continues Anand. “It can rule out other things, too, such as an inflammatory condition. Sometimes, the MRI scan is more reassuring [so patients know what they are dealing with].”

Stretching the fascia

The consultant may ask the patient to stretch the fascia, to help it lengthen and ensure a reduction of the pain. A physiotherapist may be able to help stretch it out, as can splints.

Shockwave treatment may help the fascia heal, too, as do steroid injections. The latter, however, do not treat the problem, as such, but they can relieve the pain.

“New evidence is coming through for PRP (platelet rich plasma) injections, but the studies are few and far between,” explains Anand. “If this is something that you are happy to try and your insurance supports it, it will definitely be worth a try – the logic being that PRP contains some growth factors which allows the fascia to heal.”

Lifestyle modifications for plantar fasciitis

During the consultation, your specialist may suggest several lifestyle modifications, including a change in activity levels, and/or managing the pain until things settle.

“Most people will need to change something – for example, if they are working in a factory wearing steel-toe shoes, or they regularly walk around on a hard floor, or they have started running a little more, or have put on a few pounds.” continues Anand.

“It’s a very common condition, which affects both active and sedentary people – active because people are doing more, sedentary because you are not doing enough, and you are overweight.”

“Generally, the condition affects middle-age to elderly patients – and those who have not been active for a while and then return to activity and perhaps do not properly warm up before a workout.”

A sign of diabetes

“In around 90% of individuals, the condition will settle down itself without needing anything done.” says Anand.

Sometimes, it is a sign of diabetes, because things do not heal as well when you are diabetic. Inflammatory conditions, such as rheumatoid arthritis, may also be to blame – especially in those who have a condition called bilateral plantar fasciitis.

“If you have biomechanical dysfunction of the foot, you may also be more prone to plantar fasciitis”, says Anand.

A foot specialist (a podiatrist) or a physiotherapist may be able to provide some answers regarding your symptoms – and your GP may refer you to see either. However, you may wish to seek advice from a specialist here at Circle Health Group, which should fast-track your treatment.

A physiotherapist might show you some exercises you can try to relieve your symptoms, while a podiatrist will likely recommend the right shoes to wear or the use of insoles to alleviate your discomfort.

In severe cases, you may require surgery for plantar fasciitis. Known as a plantar fasciotomy, the surgery aims to detach your fascia from your heel bone to relieve any tension. When it is healing, the connective tissue experiences new growth. This can encourage your fascia to lengthen.

Before surgery, though, your specialist may suggest using splints, taping your foot, massage, anti-inflammatory medicines, injections (either cortisone, local anaesthetic, or platelet-rich plasma injections), or extracorporeal shockwave therapy. The latter uses high-energy impulses to repair plantar fascia tissue.

Anand Pillai says: “First, you will ask the patient to change what they are doing (lifestyle changes, such as activity modification), or you might support the foot using an orthotic or an insole, which is made to measure for the individual. Otherwise, it can be a never-ending cycle of pain until you change what you do.”

A few people are more prone to getting plantar fasciitis, including athletes who may change how they run (such as roadrunners, who may run on different surfaces), people with a high BMI, and those who have subtle changes to their anatomy – for example, someone with a high-arched foot.

Those with an Achilles tendon will also be more at risk of getting plantar fasciitis, says Anand.

Want to find out more about the different ways to pay for your plantar fasciitis consultation or any subsequent treatment you may require?

Some patients choose to pay for themselves, while others will have medical insurance in place. Those who opt to pay for their foot treatment can pay over a 12-month period to spread the cost and make paying for your appointments more manageable.

Find out more about the different ways to pay for your plantar fasciitis treatment.

When you visit a specialist at Circle Health Group, you may discover that you do not have plantar fasciitis and that your symptoms are due to another condition which affects the foot. This could include:

  • Sciatica
  • Tarsal tunnel syndrome
  • Entrapment of the lateral plantar nerve
  • Rupture of the plantar fascia
  • Calcaneal stress fracture
  • Calcaneal apophysitis.

The foot specialist you see will be able to give you advice on the type of condition you may be experiencing.

Have a query about plantar fasciitis and any symptoms you may currently have as a result of the condition? You may find the answer in our frequently asked questions guide below.

Can I run with plantar fasciitis?

While running with plantar fasciitis is possible, you may find that your symptoms worsen at the start of your run. However, the pain or discomfort should ease as your run continues.

If you find that your pain worsens, take some time out to rest.

How long does plantar fasciitis last?

If you're suffering from plantar fasciitis, you may wonder how long your symptoms will persist. If you were to try home remedies, your symptoms will usually get better on their own within six months to a year.

That said, many people with plantar fasciitis will be in so much pain that they will want to seek help sooner. If this is you, visit your GP, who can refer you to a podiatrist or physiotherapist for some specialist advice and/or treatment.

How do you get plantar fasciitis?

If you are wondering what has caused your foot, heel and arch pain, it could be due to several things. If your pain and discomfort is due to plantar fasciitis, it could be a result of the type of shoes you are wearing, the structure of your foot, overuse (including a new exercise regime, for example), or walking on hard surfaces barefoot.

What causes plantar fasciitis to flare up?

Plantar fasciitis can be a painful and debilitating condition, with certain activities aggravating the condition. These could include running, walking or standing for long periods of time in shoes which are unsupportive.

Your symptoms may also worsen if you regularly walk on hard surfaces, such as concrete, or if you carry a heavy object or gain some weight.

Are high heels good for plantar fasciitis?

If you regularly wear high heels, you may wonder if you can continue to wear them while you are suffering from plantar fasciitis. In fact, this type of shoe may have caused your symptoms and may definitely aggravate them if you are already living with the condition.

It is a good idea, therefore, to swap your high heels for supportive, flat shoes, or shoes with special insoles designed for people with foot pain.

Can I wear plantar fasciitis socks to bed?

If a podiatrist or physiotherapist has recommended that you wear compression socks for plantar fasciitis, the good news is you can wear them in bed and enjoy the benefits they bring.

How can I relieve plantar fasciitis pain?

If you are experiencing pain or discomfort due to plantar fasciitis, there are several things you can try at home.

Painkillers like paracetamol may help the pain, as can icing the painful area of your foot using a bag of frozen peas wrapped in a towel. You could also try gentle stretching exercises, as recommended by a specialist, or avoiding anything which aggravates your pain or discomfort.

Can reflexology help plantar fasciitis?

Reflexology may help treat plantar fasciitis. It works by loosening the ligaments and muscles in the foot and lower leg by increasing circulation. It also improves flexibility, which may help ease your symptoms too.

Does losing weight help plantar fasciitis?

Pain management experts may recommend losing weight if you are suffering from plantar fasciitis. Weight loss can reduce the pressure and strain that spreads to the lower extremities in those who are experiencing plantar fasciitis. In the first instance, then, losing weight may be the way to go.

Does plantar fasciitis affect the calf?

Many people with plantar fasciitis pain may also experience tightness in the calf. Visit your GP or a foot specialist here at Circle Health Group to discuss your symptoms and how they might be improved.

Does plantar fasciitis cause knee pain?

Weakness in the plantar fascia can also put additional strain on your ankle and knee. If the pain associated with the condition is getting you down, visit your GP or a foot specialist for tailored advice.

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