Plantar fasciitis is normally due to repetitive stretching of the plantar fascia which is situated on the sole of the foot in the midfoot area. Despite the fact that our shoes have become more and more comfortable and we have a variety of different types of shoes such as Skechers and every conceivable type of heel cushioning this problem is affecting more and more people I see ranging from athletes to sedentary patients. Joggers, tennis players and racquet sports players as well gymnastics were to be found the most prevalent (Charles, 1999).

It is interesting to note that half of all patients with plantar fasciitis have another condition called Heel spur. The greater pull of the plantar fascia causes bleeding and inflammation leading to the laying down of new bone and heel spur formation.

The reasons why we develop plantar fasciitis are not well understood but the following reasons have been suggested (De Maio et al., 1993):
  • Obesity:              In 40% of men and 90% of women.
  • Occupational:    Prolonged standing or walking (“policeman’s heel or policeman’s foot”)
  • Acute Injury:      Less common but some people remember standing on a sharp object or pebble “stone bruise”.
  • Anatomical:       Loss of elasticity in the heel pad may be a factor in heel pain syndrome.
  • Biomechanical: People with high arches (pes cavus) and pes planus or low arches. Tight calf muscles or weakness of intrinsic foot muscles. Inadequate footwear and hard floors such as a hairdresser who I saw who was wearing tight-fitting not supportive designer shoes for 15 years and was working on tiled floors. Walking barefoot and using shoes such as Crocs will also be very unhelpful. 

It is important to rule out the following conditions:

  • Inflammatory Spondyloarthropathies: Up to 16 percent of patients with foot pain are later diagnosed with arthritis (Singh, 1997). If you suffer from pain in more than one area than blood tests are important to rule out systemic arthritis.
  • Calcaneal Stress Fracture: Sudden increase in running activities such as seen in soldiers or recruits and in runners, triathletes, ironmen, and Ironwomen. 
  • Nerve Entrapment: Tarsal tunnel syndrome.
  • Tumours: In rare cases there are tumours found in the heel area.
  • Infections: there will be swelling, redness and fevers.
  • Neuropathy (diabetic/alcoholic): a history of burning pain, numbness or tingling can often be seen in patients with neuropathic pain. 
  • Fat Pad Syndrome: Pain while hopping on toes will help distinguish plantar fasciitis from the fat pad.

To test the plantar fascia it should be stretched using a “Bowstring Test”. Ninety percent of patients with plantar fasciitis will improve significantly within 12 months but around 10 percent will develop persistent and disabling pain. 

The following treatments are suggested to help:



At the Advanced Pain Relief Clinic we have many patients who come for treatment for this painful condition and will do our best to accurately assess and treat you and provide as much pain relief as possible.




References:

Charles, L.M. (1999). Why does my foot hurt? Plantar fasciitis. Lippincott’s Primary care Practice. 3:408-409
DeMaio, M. (1993). Plantar Fasciitis. Orthopaedics. 16:1153-63.
Singh, D. (1997). BMJ. Fortnightly Review: Plantar Fasciitis. 315: 172-175.