plantar facia is a tough band of fibrous tissue that lies over the small
muscles of the foot extending from the heel to the forefoot. Its function is to
bind the small muscles of the foot together and to brace the arch thus giving
structural support to the foot.
A heel spur is a protrusion of bone/bony growth extending
from a prominence on the bottom of the heel bone. 12% of people have heel spurs
and research has shown that people who have experienced long standing Plantar fasciitis
demonstrate a higher incidence of heel spurs than normal. Many practitioners
mistakenly refer to pain in the heel as a heel spur, however the presence (or
not) of a heel spur is rarely significant in the development of pain in the
Plantar fasciitis is thought to be caused by mechanically
degenerative small tears in the muscles of the foot & plantar fascia where
they anchor themselves to the underneath surface of the heel bone. This
suggestion is supported by histological examinations of surgical biopsy
specimens and is widely accepted as being credible. Other suggestions include perifascial
oedema (swelling in the fascial area).
The suffix ‘itis’ (meaning: inflammation
of) suggests that plantar fasciitis is an inflammatory
condition and in many cases there is an inflammatory component however there is
an increasing consensus with researchers that inflammation of the plantar
fascia is rarely present and therefore the condition should be referred to as
plantar fasciaosis (‘osis’ – meaning: disease of).
Symptoms of Plantar fasciitis
Plantar fasciitis(osis) is characterised by pain
under the heel particularly when bearing weight directly after a prolonged
period of non weight-bearing e.g. getting out of bed in the morning.
The levels of discomfort can vary dramatically from a
minor nuisance to virtually immobilising the patient. Typically the condition
can persist on and off for a period of several months to a few years and can
prove difficult to clear, although in many cases will run a natural course
until resolving itself (this may take a year or two)
Pain can occur anywhere under the heel although there is
often one spot where pain is focused; if this spot is pressed it will feel very
sore. It is rare for plantar fasciitis to cause any visible inflammation or
swelling and is often unilateral (affects one foot at a time).
Who gets plantar
Excluding children plantar fasciitis can affect anyone,
particularly over 40’s who are overweight and stand for prolonged periods of
time, especially when barefoot or wearing thin or hard soled footwear with
little support or cushioning. However it can and does affect underweight and
sedentary people. More females are affected than males.
Treatment of plantar fasciitis
Treatment consists of:
1 Conservative treatments,
2 Cortisone injection (& conservative treatment),
Conservative treatments (should
always be considered first), includes:
Patients should avoid any unnecessary weight bearing
activity. It is absolutely essential to avoid prolonged standing. Compliance
will ensure greater relief of symptoms than any other form of conservative
There is compelling evidence that suggests Plantar
Fasciitis is more prevalent in people who have tight calf muscles and Achilles
tendons. Therefore patients should undertake regular calf and foot stretching
3. Heel Cup
4. Compression Foot Sleeves
Soft soled and supportive shoes i.e. TRAINERS (not
‘pumps’) to be worn at all times, even around the house. Try to alternate your footwear;
do not wear the same trainers every day.
5. Gentle Manipulation/Massage
Gently massage the ‘hot spot’ with baby oil. Alternatively roll
the heel over a rolling pin, or a tin of beans (or similar), repeat this
several times a day.
5. Night splints
6. Anti inflammatory tablets
Although research suggests plantar fasciitis causes
limited (if any) inflammation within the plantar fascia Non Steroidal
Anti-inflammatory medication (Ibuprofen)can be of help and should be used.
8. Low Dye Strapping
This form of adhesive strapping is effective in providing
an instant improvement for patients with particularly acute and debilitating cases
of Plantar fasciitis. The strapping is adhered to the sole of the foot
longitudinally from the heel to the forefoot. When applied correctly it braces
the foot preventing the arch from lengthening when bearing weight, thus
protecting the plantar fascia from tension. The strapping will remain taught
and secure for several days despite daily baths / showers. Patients can be
provided with tape and shown how to apply the strapping themselves.
Low Level Laser Treatment uses infra-red
1. Reduce inflammation 2. Enhance
wound healing 3. Stimulates tissue regeneration.
This treatment is completely safe & painless, has no side
effects, and is highly effective for Plantar fasciitis. A course of treatment
involves up to 12 sessions at the rate of two sessions per week.
Patients will begin to notice improvements
after 3 – 4 sessions of laser treatment and can then expect significant relief
of symptoms after a course of up to 12 sessions. A course of up to 12 sessions
The majority of patients who persist diligently with the
conservative treatments listed previously can expect an improvement in
However where significant symptoms do persist (after 4-6
weeks of conservative treatment) then consideration should be given to an
injection of cortisone.
Patients can be reassured that at this practice these
injections are quite painless as the foot is numbed with a local anaesthetic (Tibial
Nerve Block) prior to the injection of cortisone solution.
In accordance with recommended best practice we audit all
outcomes for Cortisone injections. We achieve exceptionally high rates of cure
for Plantar Fasciitis with these injections (since 2009 we have achieved cure
rates of 95%).
You don’t need to tolerate the persistent misery of
Call today and allow us to put our vast expertise into
action. It is highly probable that we can cure your heel pain.
“Hollinshead & Associates
have provided excellent service in caring for my feet. In particular a long
standing problem of pain in my right foot (Plantar Fasciitis) has been
completely cured by a steroid injection delivered painlessly after a local
anaesthetic. The staff Mark and Sarah plus the women on reception are most
caring, considerate, and professional”.
Mrs J Pilton, Northwich.