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Plantar Fasciitis

Plantar fasciitis refers to inflammation of the plantar fascia, which is a section of tissue that stretches from the heel to the middle bones in the foot.

  1. Main symptom is pain underneath the heel
  2. Caused by overuse and repetitive strain
  3. Will improve by itself but sometimes surgery is required

Pain in the heel and foot is fairly common from time to time, and can be particularly uncomfortable if it stems from strenuous exercise. If pain in your plantar fascia is severe, this could be an indication of plantar fasciitis; in which case, you may want to speak to a doctor about how to relieve symptoms. Our online video consultation enables you to speak to a UK doctor at your own convenience.

Plantar Fasciitis
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Description

What is plantar fasciitis?

Plantar fasciitis is the inflammation of the plantar fascia. This thin tendon resembles a band between the middle bones in the foot and underneath the heel. It can affect anyone, although it’s most likely to impact on people over the age of 40. The exact cause is unknown, but it is thought that the repetitive process of regeneration and degeneration of the tissue (through overuse) leads to inflammation.

The condition is likely to affect someone who is on their feet for long periods of time, or someone who does a lot of exercise that puts pressure on the feet. It’s a common problem for athletes, particularly those who move in a way which stretches the plantar fascia suddenly, such as sprinters. If you have consistently worn shoes that do not provide sufficient arch support, this may also cause you to walk in a way that aggravates this area, and results in symptoms. You are at a greater risk of developing plantar fasciitis if you’re overweight.

Plantar fasciitis is thought to affect around 10% of people in their lifetime, and the condition accounts for 80% of all reported heel issues. There is no increased prevalence in men or women.

How can plantar fasciitis be prevented?

Plantar fasciitis can't be completely prevented, but there are a few measures that can be taken to decrease the chances of getting it. If you run regularly, it’s important to change your shoes often so that the heel cushion does not wear too much. If you’re overweight and putting too much strain on your foot, losing weight could help, as well as regularly stretching both the plantar fascia and achilles tendon before exercise.

Complications from treatment not involving surgery are very rare for plantar fasciitis. However, there are a couple of complications that can result from surgical intervention. Lateral column (the outer side of the foot) pain happens in around one third of patients after surgery, and nerve damage can follow endoscopic surgery.

If you’re experiencing pain in the foot and want to speak to a doctor, our video consultation service can put you in touch with a UK practitioner. Appointments are available through our secure service. Our doctors can issue advice on how to alleviate symptoms and recommend treatment where necessary. Book a slot at a time that’s convenient for you.

Page last reviewed:  16/06/2020
Diagnosis and treatment

What causes plantar fasciitis?

Repeated stretching of the fascia is thought to be the cause of plantar fasciitis. This may happen due to repetitive strain from exercise, such as long distance running. Obesity and standing on hard surfaces for long periods are also thought to be risk factors.

The pain associated with plantar fasciitis occurs when the plantar fascia is repairing and regenerating itself, after many small injuries.

How is plantar fasciitis diagnosed?

A diagnosis for plantar fasciitis can be made from a doctor’s physical examination. They will most likely ask you about the nature of the pain, and what kind of physical activity you have recently been doing. 

A typical symptom of plantar fasciitis is a sudden stabbing pain in the heel. This pain will be more intense just after getting up, or after an extended period of inactivity. It may be less intense during normal activity, but worsen throughout the day, particularly after standing up for long periods, or walking. 

Having identified the symptoms, a doctor may examine your foot and put pressure on the plantar fascia to look for tenderness. They may also ask you to walk to see whether the motion is abnormal.

Will I need tests?

There are no investigations further to the physical examination for plantar fasciitis. The only test that a doctor may decide to check is the windlass test, which involves straightening the leg and lifting the toes to stretch underneath the plantar fascia.

If a doctor suspects a more serious injury is present, they may send someone for further tests, such as an x-ray.

How is plantar fasciitis managed?

There are three main categories of treatment for managing plantar fasciitis. It’s important to rest the foot by avoiding any strenuous exercise that may worsen the plantar fascia. It’s also advisable to wear footwear with a cushioned heel, accompanied with arch supports and heel pads if necessary. Painkillers such as ibuprofen can help to reduce inflammation.

The next stage is self-physiotherapy. There are several exercises that a doctor or physiotherapist will recommend to speed up your recovery. An example of a typical exercise is standing on a slightly raised surface, such as a step, with the heel off the end, and then lowering the heel with the knee straight.

If these non-pharmacological treatments are ineffective, a steroid injection may help to relieve pain for a few weeks, but there is a risk of damaging the tendon, and so it’s not usually recommended. In rare cases where pain has not subsided for many months, surgery can be performed to separate the point at which the plantar fascia connects to the bone. However, there are potential complications with this; it should only be considered as a last resort.

Page last reviewed:  16/06/2020
Questions and Answers

How is plantar fasciitis treated?

Plantar fasciitis is usually treated by allowing the foot to rest, and performing exercises to aid recovery. Immediately after the onset of pain, it’s advisable to avoid any strenuous activity which could further damage the tendon. Anti-inflammatory painkillers can be useful in relieving soreness.

There are several exercises that a doctor or physiotherapist will recommend to help restore mobility, which should be repeated daily until the pain subsides. In very rare cases, surgery may be necessary, but it should be seen as a last resort for treatment.

How long will it take for me to recover?

It can take a long time to recover from plantar fasciitis, as the plantar fascia is very delicate and difficult not to use regularly. Most people will recover within a year, provided they look after the foot. The more you follow a treatment plan with an exercise schedule, the faster your recovery is likely to be.

Can I consult a doctor about plantar fasciitis online?

Our UK doctors are available to speak to using our online video consultation service, should you have foot pain or any concerns about plantar fascia. They will be able to suggest what exercises would be suitable for you, and recommend a physiotherapist, where appropriate. They are available to consult with at a time that’s suitable for you.

Page last reviewed:  16/06/2020

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