Plantar Fasciopathy
Overview
Plantar Fasciopathy is a very common cause of heel pain. The Plantar Fascia is a strong band of tissue that arises from the under surface of the heel and attaches to your toes. It helps maintain one of the arches of the foot. Plantar Fasciopathy is when this structure becomes painful, typically under the heel and especially when you get out of bed in the morning and after a period of rest.
The natural history of Plantar Fasciopathy is for the pain to resolve, but unfortunately this often takes many months. Thankfully, Plantar Fasciopathy does not spread to other parts of your body, but it can happen in the other foot.
The cause of the pain is thought to be an “overloading problem”, with too much load being transferred to the plantar fascia of the foot. Therefore, treatments aim to reduce the load applied to the plantar fascia. Thankfully, surgery is only rarely necessary.
Non-Surgical Treatments
Weight Loss
The less weight being loaded through the foot, the less irritable and painful the Plantar Fasciopathy, so weight loss is an important part of treating your Plantar Fasciopathy.
Physiotherapy
This is the most essential part of the treatment. By loosening and stretching these muscles, there is less weight transferred to the plantar fascia when you walk and thus it becomes less irritable. The stretching programme should be performed twice a day for 12 weeks. Stand on the edge of a step, with the body weight on the forefoot of the painful leg and load the calf muscle by lowering the heel below the level of the forefoot. Push back up the other leg, in order to avoid concentrically contracting the affected muscles. The exercise should be performed with the knee of the affected leg, both straight and bent, to stretch different muscle groups. The two exercises (knee straight and bent) should be performed 15 times and repeated 3 times (3 reps of 15 stretches with knee straight and the same again with knee bent). Expect some muscle soreness.
As the exercises gets easier, add a weighted back-pack to add further stretch to the muscle groups. Light jogging may be commenced once the pain reduces to a mild discomfort. Severe pain merits a return to your physiotherapist for a review.
Ultrasound
Your physiotherapist will guide you through this treatment.
Deep Massage
Your physiotherapist will guide you – often rolling the sole of your foot on a golf ball is useful. Another option is to freeze a 500ml plastic bottle full of water and roll your foot over it.
Shock Absorbing Heel Pads
These should be available from your local chemist.
Ice Packs
Use a bag of frozen peas wrapped in a tea-towel (buy Irish!)
Anti-Inflammatory Medications
Tablets are often prescribed during the initial acute flare up, but for more chronic pain, the anti-inflammatory gels are equally effective, without the tummy irritation.
Night Splints
These are soft sock type devices, to be worn every night, which hold your ankle in a position that stretches your calf muscle through the night. They are available in specialist shops such “Foot Solutions”.
The majority of patients will respond to the above measures over a 3-month period. It is vital that all of the above treatments are used together with the advice of a physiotherapist. If all the above fail, you can try:
Injections
Plantar Fascia injections are painful but can give short-term easing of the pain, while providing a “window of opportunity” to re-engage with your physiotherapy treatments.
Shock Wave Therapy
This treatment applies further ultrasound to the affected area and can be very useful in resistant chronic plantar fasciitis.
Surgical Treatments
This involves release of the calf muscle. It is reserved only for those patients who have tried all the non-surgical treatments under the guidance of a physiotherapist. It is performed as a day case procedure, and you can mobilise as tolerated following the surgery.
