A common cause of heel pain. It is inflammation of the sheet of tissue (plantar fascia), that forms the arch of the foot, going from the heel to the toes. It results from overuse or being overstretched, causing inflammation and micro-tears. Can occur after a recent change in foot wear or activities.
Pain is typically described as a stabbing pain under the foot and heel. Patients often complain of pain when starting to weight-bear, it can then ease off with more weight-bearing (as it stretches) but returns with prolonged weightbearing (overuse).
Initial treatment should include a combination of analgesics, non-steroidal anti-inflammatory medication, silicone heel cups/orthotics and stretching exercises. Night splints may also be utilised to keep the fascia stretched – this prevents the plantar fascia from returning to its normal resting position at night which becomes painful when stretched in the morning.
If these measures fail, extracorporeal shock wave therapy can be used (if available) to transmit high frequency shockwave impulses to the area of inflammation. This helps break down the scarring that is often present with inflammation and allows the stretching exercises to be carried out effectively.
Another option, if shockwave therapy is not wanted or available, is needling of the fascia and injection with corticosteroid. I perform this procedure under sedation in an operating theatre as the needling can be quite painful. During this procedure I use a hypodermic needle to scratch the scarred plantar fascia off its insertion to help break it down to allow stretching. Corticosteroid is also administered after the needling to help reduce inflammation.
Rarely, surgical intervention is required due to non-resolving symptoms despite non-operative management. With this procedure an incision is made on the inner aspect of the back of the heel to release the plantar fascia and release a nerve that is often entrapped.
You will find your foot in heavy bandaging and a walking boot will be applied before you go home. You will be provided with crutches for support, and you will be permitted to weight-bear in the boot. Elevation, as much as possible, is important in the first few weeks. This boot will be removed in 2 weeks’ time for a wound check and physiotherapy will be started.
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, failure for symptoms to settle and irritation from the wound.