Plantar fasciitis is by far the most common sports injury presenting to the sports clinician and  affects 10% of the general population

With the exception of trauma, it is the most frequent cause of chronic pain in the heel is a musculoskeletal disorder primarily affecting the fascial insertion into the heel bone.

It is thought to have a mechanical origin and is thought to be associated with increased body mass (BMI) and lower limb biomechanical anomolies Inflammation is only rarely observed and so the condition should probably just be called “plantar heel pain”, because “itis” denotes the presence of inflammation. In this regard, anti- inlammatory agents (eg. Ibuprofen) will not help the condition.

The absolute key to treatment is to seek the earliest possible expert help.

Pain from plantar fasciitis is often most noticeable during the first few steps after getting out of bed in the morning. The plantar fascia is a thick band of tissue in the sole of the foot. Micro-tearing at the origin of the plantar fascia on the heel bone (calcaneus) can occur with repetitive loading.

Management

Early diagnosis and intervention is a key factor in this condition to prevent the problem becoming chronic and therefore harder to resolve.

The good news is that 85% of patients with symptomatic plantar fasciitis will respond to conservative management, with surgery indicated for the remaining 15%.  (Lutter (1997).  However this reports concludes that plantar fasciitis is a degenerative, not inflammatory process, which contradicts the bulk of the literature and the pathology and imaging studies.

Do’s and don’ts for plantar heel pain

 DO …

  • Seek expert opinion on this ASAP. The earlier the intervention, the better the outcome!
  • Consider taping of the plantar fascia in the short term.. This has proven benefits for pain and function
  • Consider an orthotic device, either custom made or generic, especially if the taping offers good pain relief.
  • Stretch both the plantar fascia and the calves. Your sports medicine practitioner will teach you how. Be diligent!
  • Recognise the importance of footwear, both athletic and non- athletic. Get the right advice!
  • Consider therapies like shock wave therapy if the heel pain has been present for more than 6 months and has resisted all other therapy.
  • Maintain a healthy body weight

DO NOT

  • Run barefoot or in shoes with a low heel
  • Consider PRP (platelet rich plasma) therapy!

 

Local Steroid injections: For recalcitrant plantar fasciitis, a therapeutic steroid injection will sometimes be required. This can be helpful in breaking the cycle of pain. Injections will not change the underlying biomechanics, so they typically need to be combined with a rehabilitation program as previously described.