FAQ on Plantar Fasciopathy (Fasciitis) with Mr Charalambos Charalambides

What is the plantar fascia?

The plantar fascia is a very strong ligament that extends from the heel to the toes and helps to balance various parts of the foot while walking. It also helps to maintain the plantar arch.  It, therefore, takes a lot of stress during the walking cycle. Micro injuries and repetitive strain on the plantar fascia can cause inflammation, particularly at the insertion of the plantar fascia onto the heel bone, however, sometimes it happens in the mid-part of the foot.

What are the symptoms of plantar fasciopathy (fasciitis)?

The most common symptom is pain. The pain is usually located in the region of the heel however sometimes it appears in the mid-part of the foot on the plantar surface. It is more pronounced first thing in the morning and is aggravated by prolonged standing and walking. Towards the end of the day, it may be more severe.

Change of walking habits, gaining of weight, obesity, walking on hard surfaces and use of shoes with little or no support can trigger the symptoms.

Can a heel spur cause the pain?

A heel spur is an extra little bone that grows very close to surface where the plantar fascia meets the heel bone. Heel spurs are common in people with plantar fasciitis, however, they can be found in people with no heel pain at all. It has been proved that the heel spur is probably part of the condition, however, the spur alone is not itself the cause of the pain.

What treatments are available?

Non-operative treatment:

• Use ice packs to the painful area for 20 minutes, preferably two to four times a day.
• Use of Silicone heel cups:  This helps to split the load and provide shock absorption and cushioning during walking.
• Shoe Insoles:  These are particularly useful with patients who have flat feet. This can be custom-made or over-the-shelf.
• Physiotherapy:  Sessions of physiotherapy consist of stretching, which is the main exercise to decrease the pain. Also, massage can be done with a soft tennis ball or roll a can of cold Coke on the floor.
• Shoes:  It is advisable that patients use wide-fitting shoes with arch support incorporated and lots of cushioning to absorb the shocks during the walking cycle. Avoid walking barefoot on hard surfaces especially at home. Use good quality slippers which provide good cushioning during walking indoors.
• Strapping:  Occasionally physiotherapists may use strapping tape to support the arch during walking. This decreases the tension of the plantar fascia on weight-bearing.
• Night splints:  These can be worn in bed.  They are specifically designed foot braces to stretch the plantar fascia overnight. These are effective with patients who have a lot of pain first thing in the morning when they get out of bed.
• Shockwave treatment therapy: This is a therapy that has been used in England and Europe for the last 10 to 15 years. It is particularly useful with insertional plantar fasciopathy with pain mainly in the heel. It is proven that it helps in about 75% of intractable plantar fasciopathy cases with symptoms lasting more than six months or a year.
• Medication:  Conventional painkillers and anti-inflammatory medication can help with the pain relief however this does not cure the condition.
• Injections:  Some doctors prefer to administer steroid injections into the heel for immediate pain relief during the acute phase. However, it is doubtful whether these injections have long term effect.  It is also doubtful whether these injections should be given in the area as they can cause complications with devastating effects for the patient.

Surgical treatment

This is very rarely required for plantar fasciopathy (fasciitis). It should only be considered in patients who do not respond to physiotherapy and other non-operative treatment after 12 months. It is indicated in patients who have a very tight Achilles tendon. The traditional way of surgical treatment was to release part of the plantar fascia. However, recent research suggests that the release of the medial head of the Gastrocnemius muscle (Achilles tendon) just below the knee cavity improves symptoms in 82% of patients.

Exercises

Usually, plantar fasciopathy (fasciitis) gets better eventually over time. However, when it happens once you are more likely to have it appear again. It is advisable to continue with stretching of the Achilles tendon regularly to avoid further episodes.

What is the long-term outcome of treatment?

In most of the patients, the pain settles with physiotherapy and stretching. However, the treatment can take a long time, up to six months or a year. There is a small percentage of patients where the plantar fasciopathy (fasciitis) never gets better and the pain persists for many years.

What are the other causes of heel pain?

• Thinning or weakness over the hard part of the heel
• Injury to the bones or padding of the heel
• Referred pain from arthritic ankle or subtalar joint pain
• Irritation of the nerves on the inner side of the heel
• Fracture of the heel bone
• Soft tissue calcification around the heel
• Bone cysts
• Primary or metastatic bone tumours
• People with systemic inflammatory diseases such as rheumatoid arthritis or ankylosing spondylitis

Mr Charalambos Charalambides qualified as a medical doctor from the Aristotle University Medical School of Thessaloniki in Greece. Following completion of two Orthopaedic training programmes in Greece & England, he has gained a wide experience in all aspects of Orthopaedic Surgery.

His special interest is Foot and Ankle surgery, including trauma to the Ankle and Foot in adults. He performs lower limb arthroplasties and arthroscopies and treats all aspects of trauma patients having complex fractures.

A private consultation with Mr Charalambides at Highgate Private Hospital costs £250 if you are self-funding your treatment. We accept all major health insurers, but please contact your insurance company prior to booking an appointment if you plan to use your private health insurance.