Plantar fasciitis: Symptoms, causes and treatment

What is plantar fasciitis?

Plantar fasciitis is a painful condition that affects the plantar fasci - a thick band of connective tissue that is found in the sole of the foot. It is one of the most common complaints that patients speak to our physiotherapists about. 

In this article, we will delve into the world of plantar fasciitis and explore what it is and how it can be treated.

What are the symptoms of plantar fasciitis?

The hallmark symptom of plantar fasciitis is sharp, stabbing pain in the heel, especially when taking the first steps in the morning or after long periods of rest.

The affected area may be tender to touch, and you might experience mild swelling. 

Plantar fasciitis can typically develop gradually over time, often affecting one foot but it can affect both feet in some patients. 

What causes plantar fasciitis?

Activities that place load or force through the plantar fascia, such as running, walking, or standing for extended periods, can exacerbate the pain. Sometimes this occurs during the activity, but more commonly after a period of rest following such an activity. Other causes of symptoms include rapid changes in training pace or volume, or a change in the type of footwear you typically wear.

Plantar fasciitis can be really common after summer holidays – when you might be much more active than you are in your usual life and wear different styles of footwear for longer periods than usual. 

Other risk factors include age, altered foot biomechanics and improper gait, or any condition which affects the elasticity and shock-absorbing capabilities, resulting in the plantar fascia being more prone to injury.

How do I know if I have plantar fasciitis?

Several conditions can mimic the symptoms of plantar fasciitis, which is why it’s important to book an appointment to see a physiotherapist and get their guidance. Having an accurate diagnosis is essential for effective treatment.

Some of the conditions that need to be ruled out include:

• Calcaneal stress fracture: This may occur following a fall. This condition requires immediate attention if you are unable to weight bear and may present with similar symptoms to plantar fasciitis, necessitating proper evaluation and diagnosis.
• Nerve compression: Conditions like tarsal tunnel syndrome or nerve impingement can manifest as heel pain and must be ruled out through thorough assessment.
• Achilles tendon pain: Differentiating between plantar fasciitis and Achilles tendinitis is crucial, as their treatments can vary significantly.
• Referred pain: Lower back issues or sciatica can sometimes refer pain to the heel, mimicking plantar fasciitis.

What is the best treatment for plantar fasciitis?

The treatment options for plantar fasciitis can vary depending on what is found during your assessment. But here are a few examples:

• Physiotherapy: Stretching and strengthening exercises for the foot and calf muscles can be instrumental in alleviating symptoms and preventing recurrence.
• Orthotics: Custom-made or over-the-counter shoe inserts can help distribute pressure evenly and provide support to the foot arch, easing strain on the plantar fascia.
• Footwear modification: Educate patients about suitable footwear that provides adequate cushioning and arch support and advise against unsupportive shoes.
• Cold therapy: Applying ice packs to the affected area can reduce inflammation and relieve pain temporarily.
• Night splints: These can help keep the foot in a dorsiflexed position, stretching the plantar fascia and Achilles tendon while the patient sleeps.
• Non-steroidal anti-inflammatory drugs (NSAIDs): In some cases, short-term use of NSAIDs may be appropriate to manage pain and inflammation.
• Extracorporeal shockwave therapy (ESWT): For chronic cases, ESWT can be considered to stimulate healing and reduce pain.
• Corticosteroid injections: In severe cases, a corticosteroid injection may be considered for short-term relief, but repeated use should be avoided due to potential complications.

How can physiotherapy help plantar fasciitis?

Plantar fasciitis can be a frustrating and painful condition, impacting an individual's quality of life. Physiotherapists are trained and experienced to recognise the signs and symptoms accurately which is important in providing timely and effective treatment. 

With proper care and appropriate interventions, most patients can recover from plantar fasciitis and resume their daily activities without persistent pain. It is important for patients to actively participate in their recovery through lifestyle modifications. Targeted exercises are key to achieving long-term relief and preventing recurrence.