Plantar Fasciitis
What is Plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain affecting 1 in 10 people in their lifetime and 8% of running injuries. It is also common among those who are less active, affecting all ages and backgrounds.
This condition which causes pain in the heel, arch and/or sole of the foot, can have a profound impact on quality of life, affecting one’s ability to simply walk without pain, undertake social activities, work and hobbies. The good news, however, is that the condition is very rarely serious, the prognosis is good and there are things that you can do to set yourself up for a successful recovery.
It is caused by irritation of the ‘plantar fascia’ ligament. This strong ligament connects the heel to the ball of the foot and plays a vital role in supporting the arch of your foot – taking the strain when you stand, walk or run.
Symptoms of plantar fasciitis may include:
- Pain in the heel, across the sole of the foot (the part that touches the ground) and sometimes it can spread into the arch area of the foot too.
- The pain may be described as sharp, aching and burning.
- The pain is usually worse when you first place weight on your foot, for example, when you get up in the morning or after long periods of sitting.
- Pain often feels better during exercise, but returns after resting.
- The pain can worsen as the day goes on and/or after long periods of weight bearing such as standing or walking for a long time.
Factors that may play a role in the development of plantar fasciitis include:
- A sudden increase or change in activity levels. For example, this may be an increase in running training volume or walking (e.g. longer, faster or hillier walks) or being on your feet for prolonged periods.
- Being overweight, particularly weight around the middle.
- An inactive, sedentary lifestyle.
- Flat foot posture or high arches.
- Tight calf muscles or stiff ankles.
- Certain health conditions such as diabetes and high cholesterol.
- Smoking.
- Plantar heel pain can be triggered by life changes, including periods of stress, illness or feeling run down.
Go to A&E immediately if:
- your ankle or foot that has changed shape or is at an odd angle
- you heard a snap, grinding or popping noise at the time of injury
- you are not able to walk
- your calf is red, hot, tight and/or swollen which may also be tender to touch
- you have foot pain and feel generally unwell and have a high temperature or feel hot and shivery
3 facts about plantar fasciitis
A scan cannot diagnose plantar fasciitis. Plantar fasciitis is a ‘clinical diagnosis’, i.e. one that is made in clinic with you and a clinician, taking a careful history and testing the area. Routine scanning is therefore not required. Scans also don’t predict how much pain you feel, and image findings are often unchanged when people do get better. Scans may also show things which are not even relevant to your pain. For example, we know that up to 50% of people with no symptoms of plantar fasciitis will have a bony heel spur on their ultrasound scan.
Pain can be worrying; it can make you feel the need to stop or avoid your normal activities. Although this is understandable, evidence shows that prolonged rest will only hinder recovery in the long run. Engaging with strengthening and general exercise gradually and frequently reduces the symptoms and increases the tolerance of the plantar fascia to load over time.
It is ok for it to be sore during exercise as you are training a sore area. Pain is not a sign of damage. However, to ensure that your recovery is smooth rather than erratic, it’s recommended that you find a level of activity which you can do on a regular basis. If pain increases so much that you cannot repeat your activity the next day, you may benefit from scaling back in order to be consistent. This approach requires patience, but rest assured that over time you will be able to gradually build this up again.
It will be painful when you take your first steps in the morning and it’s likely the last symptom to go. It will even happen when the plantar fasciitis has resolved, if you’ve done a lot of activity the day before. If it settles after 5-10 minutes and then it’s not painful for the rest of the day and does not limit you then take that as normal.