Plantar Fasciitis: What it is and how to treat it

While a great deal of us have heard of the condition known as Plantar Fasciitis, far fewer may know exactly what it is, how it affects us and how exactly it is treated. Despite its rather exotic name, it is quite a common condition, one which can cause a great deal of pain on the underside of the foot, typically under the heel but also along the arch of the foot causing tenderness to the touch. It is a condition that can be particularly bad after periods of non-weight bearing, for example getting up in the morning or after long periods seated. It can also cause pain after long periods on your feet, yet you might be fine while you are active. Typically the pain subsides at some stage, and the condition itself can also be temporary, lasting anywhere up to around a fortnight. For some, however, it can be a longer term problem requiring professional advice and medical intervention.

Causes

Plantar Fasciitis develops when the tissues running between the heel area up to the foot’s arch become inflamed. This area acts as the body’s natural shock absorber but can easily become damaged from repetitive daily wear and tear, sudden impacts or just something as simple as a barefoot walk across hard ground. There are links between the onset of Plantar Fasciitis and a sudden increase in activity levels, placing those who might have started jogging, joined the gym or taken up other physical activities at more risk. There are also strong links between the condition and obesity as well as those with flat feet.

Diagnosis

Generally, if the condition hasn’t improved within a fortnight, it may be a longer term issue and making an appointment with your local GP should be considered. Typically your doctor will explore the history of your condition and undertake a physical examination to rule out other potential causes of the pain. This may involve touching the heel to see if it causes pain and asking you to flex your toes upwards to tighten that area between heel and arch (the fascia) to examine it under tension.

Ultrasound might also be an option to help ascertain the fascia’s thickness. A thickness greater than 4mm is generally indicative of the condition and a diagnosis can be made.

Easing the pain

There are several things you can undertake yourself to help alleviate the pain caused by Plantar Fasciitis. The most common (and one of the most effective) is comfortable, supportive footwear with particular focus on the heel and the arch of your foot, making trainers and sports shoes ideal. The comfortable shoes should raise your heel a little bit and support your arch. Stretching your calf muscles three times a day for a few minutes is also very effective. Rolling your foot over a small soft ball such as a golf or tennis ball is also effective for stimulating and helping to stretch your foot. Some people also find pain relief from the application of ice packs or packs of frozen peas wrapped in a towel every few hours. For those still looking to keep fit and active, swimming or cycling is an ideal form of non-weight bearing exercise.

Important things to try and avoid are long periods on your feet, walking barefoot (particularly on hard surfaces) and any footwear that is backless such as flip-flops or sandals. Whether Plantar Fasciitis is a condition you’re able to successfully manage and treat at home or whether you need the advice and support of an orthopaedic foot and ankle specialist, effective treatment is nearly always a combination of understanding and managing the mechanics of your foot and treating the problem area. In persistent painful cases a steroid injection or extra-corporeal shockwave treatment might be needed to help combat inflammation. Extra-corporeal shockwave treatment is a well recognised, successful and safe treatment option which stimulates the soft tissue to heal within a short period of time. 

Sufferers generally make a full recovery but it is important to remember that often there is a specific reason why people develop Plantar Fasciitis in the first place. This is the key reason why seeking the help of a medical professional is a good idea, to help ascertain the root cause of the problem and prevent it from recurring further down the road.

Tight calf muscle

Many problems in the foot and ankle can be associated with problems “higher up” in the leg. In particular, the gastrocnemius muscle plays an important role and can be linked to many foot and ankle pathologies. The gastrocnemius muscle is the biggest muscle in the lower leg and together with the soleus muscle forms the Achilles tendon.

High heeled shoes and prolonged periods of sitting at a desk can be linked to reduced flexibility of the calf. Often a genetic predisposition is responsible for the reduced “dorsiflexion” of the ankle/foot which means one has not enough movement “upwards”. This tightness can lead to many common problems in particular Achilles tendinopathies, plantar fasciitis, forefoot overload, hallux valgus and hallux rigidus, stress fractures, metatarsalgia and sesamoiditis. A dedicated stretching regime is essential in order to improve the flexibility of the calf muscle. In a few cases this may not prove sufficient and if symptoms persist a minor operation can be performed either on its own or in association with other operations to eliminate the problem. This so-called “proximal gastroc release” is a very small operation where the “tight portion” of the gastrocnemius muscle (aponeurosis) is cut which then allows the muscle to stretch appropriately. The procedure is done as a day case and does not need any “protection” afterwards. Patients can walk unaided and after a few days of rest can resume most activities again.

Martin Klinke is a leading foot and ankle specialist and available for appointments at leading centres in London.

Plantar plate repair

Lesser toe deformities are a common problem and often associated with big toe deformities. The lesser toes are linked to the foot by multiple soft tissue structures, the strongest one is on the sole of the foot and is called the plantar plate.

With forefoot overload, this structure can rupture and until recently this problem was very difficult to treat. Detecting this pathology with the help of thorough clinical examination and an MRI scan can lead to a successful repair of this important stabiliser of the toe joints. Special techniques and dedicated instruments now allow to repair the plantar plate. This means that the plantar plate is re-attached to the toe, therefore, the function of the toe is preserved.

This makes extensive and “debilitating” forefoot surgery unnecessary.

Are you suffering from pain or problems with your feet, contact me today.

Cartiva Implant

Pain in the big toe joint can be caused by inappropriate footwear, big toe deformity, inflammation in the joint or some wear and tear in the joint. Once cartilage is damaged it does not grow back. This can lead to arthritis in the big toe joint called hallux rigidus. When conservative treatment has failed, surgery becomes an option. In milder forms of degeneration, one can perform a cheilectomy which removes prominent bone and any inflammation in the joint. In the more severe cases, a fusion of the big toe joint becomes necessary. This means the joint is made stiff and does not move.

For a few years now a new implant has become available that provides another successful treatment option. The so-called Cartiva implant “resurfaces” part of the joint, it helps to reduce the pain further and preserves the range of motion. This implant is a synthetic substance similar to the one used in contact lenses. Implanting the device does not need a lot of bone resection but is rather a “resurfacing” of the joint. So far, short and midterm results have been very good, reducing the need for a fusion substantially. The Cartiva implant is associated with very high patient satisfaction rate.

If you are suffering from pain in the big toe joint, contact me today.