This common and very often painful condition of the foot is sometimes described as a heel spur.
Whilst this latter description is not totally incorrect (as a bone spur or calcaneal spur is often seen on x-ray in conjunction with a diagnosis of plantar fasciitis) the spur is sometimes found in the absence of pain and is therefore considered a secondary factor in the diagnosis.
Plantar fasciitis arises from inflammation of the plantar fascia – a thick, strong piece of connective tissue that attaches to the heel bone and then into the toes at its other end (see Figure A).
It is usually an overuse condition that is associated with foot problems such as low arches or “flat feet”. In younger, fitter individuals it is seen in repetitive activities such as running, dancing etc. Inappropriate footwear combined with overuse is a common cause in the older patient. Tight lower limb muscles, especially the calf muscles, are often seen with this condition.
The classic signs of plantar fasciitis are increased pain and stiffness in the morning, pain during and after activity, and in the chronic phase pain present with all weight-bearing activities.
Treatment is most often a combination of “management strategies” and actual interventions. These include:
- modification of activities
- ice/stretching of calf muscles
- anti-inflammatory medication
- taping techniques (see Figure B)
- footwear assessment by a podiatrist, orthotics if needed
- strengthening the intrinsic muscles of the foot
- local ultrasound / massage
- cortisone or autologous blood injection
- surgery in cases where all conservative measures have failed
Plantar fasciitis can often be relieved with early, simple strategies – so getting an accurate diagnosis from a sports physician, a physiotherapist, or a podiatrist is an important step in getting back to your favourite activity.