Plantar Fasciitis

The plantar fascia is a layer of connective tissue on the sole of the foot. When it becomes inflamed, you have plantar fasciitis (PF).

Symptoms of Plantar Fasciitis

The bone of the heel is called the calcaneus. PF usually starts with a sharp pain at the front-most tip of the calcaneus. It may be located more towards the inner arch than the centre of the foot, and pain may radiate towards the toes. It may be worse when stretched- so walking can be painful. However, as you continue to walk, it may ease up. Symptoms return after rest.

There are a number of conditions that behave similarly, such as problems with a nerve. Your osteopath can give you a diagnosis at your appointment.

What Happens in Plantar Fasciitis

Fasciitis is inflamation of the layer of tissue between skin and muscle. There is a thick layer of fascia on the sole of the foot (the plantar aspect) which behaves like a tendon to some degree. Plantar fasciitis may begin with micro-tears to the tissue, similar to what happens in a ligament with a minor sprain. This may be an injury associated with sports, or it could be the result of normal ageing and degeneration. The symptoms become more significant if they don’t self resolve. Some consider it a degenerative condition leading to inflammation, rather than an inflammatory condition in itself. This is not to say that there is no way out of it- improving local tissue health will enable better healing.

Sometimes it is called “policeman’s heel” in reference to the repetitive trauma of persistent walking. You may also hear people talk about “heel spurs” in reference to plantar fasciitis, but this is misleading as heel spurs are protrusions made of bone, and not present or relevant in all cases.

Plantar fasciitis is a common injury in runners, but it also affects 10% of the non-athletic population. Onset does not have to be traumatic as such, but wearing unsupportive or restrictive footwear can play a role. Flip flops and high heels are noted as common factors in the development of PF.

Plantar Fasciitis FAQs

Q: Who is most at risk for developing plantar fasciitis?
A: Women are much more affected than men, and cases are highest among the 45-60yo cohort. Obesity is also a risk factor.

Q: What does PF feel like? Could it be mistaken for something else?
A: PF typically feels like instant tenderness as soon as you get out of bed in the morning. The pain is unlikely to affect you too much while you’re not weight bearing, so shouldn’t impact your sleep much. But after rest, when inflammation can build back up, soreness reappears. This discomfort should reduce while on the move, as the inflammation moves along in response to activity. Although if your footwear is particularly uncomfortable, you might not get this relief.

Plantar fasciitis is the most common orthopaedic foot problem, but that’s not to say it couldn’t be mistaken. Pain may radiate from a similar area due to a trapped nerve, including Morton’s Neuroma. However, on examination this suspicion should be questioned quickly.

Q: Should I be thinking about orthotics?
A: For short term relief, although footwear might make a difference, orthotics will likely make you feel worse before you feel better. The aim of orthotics is to correct the way the joints of your foot work. Like getting new glasses, this adjustment can take a while to get used to. Although in the long term, you might be better off getting them fitted as soon as possible, there is a risk of secondary aches and pains. If the discomfort they cause initially, which would be heightened by the tenderness of the PF, makes you compensate in your movements, you might find that your foot pain multiplies. An achey ankle, irritable knee, and sore lower back might be less likely if you can get on top of your pain levels before adding something new to the mix.

Before starting with custom made orthotics, assess how comfortable your usual shoes are. If you wear high heels or flip flops a lot, maybe try to minimise how often you wear those instead.

Treatment and Advice

Dry needling and acupuncture have been investigated as potential treatment methods, and results suggest that they may provide some benefit. In the same paper, manual therapy was found to be more effective than corticosteroid injections for plantar fasciitis. Shockwave therapy has also been suggested as a potential therapy.

Your osteopath will look at the surrounding areas, not just the sore spot. Tension through the calf can translate down to the sole of the foot. Anecdotally, working on improving calf tension and ankle mobility seems to have a significant benefit for PF symptoms. Your treatment plan will be tailored to you depending on findings from your initial and follow up consultations.

PF can take a while to clear up, so it’s worth doing everything you can to help it on its way. Your osteopath can help you with the details, but the NHS recommends avoiding shoes that are tight or lack support, and to limit the time you spend standing.

If you’re suffering with foot pain, book an appointment now.