Plantar Fasciitis

What is Plantar Fasciitis?

The plantar fascia is a thick bank of strong fibrous tissue on the sole of the foot. It runs from the back of the heel to the base of the toes. It helps hold up the arch of the foot and is under substantial tension every time you take a step.

Plantar fasciitis is a condition in which the plantar fascia becomes thickened, worn and painful. This most commonly occurs where at the point where the fascia comes off the back of the heel on the sole of the foot. The plantar fascia is linked to the Achilles tendon and calf muscles so tightness of the calf muscle will often exacerbate the problem.

Who gets it?

Plantar fasciitis can affect anyone but there are two groups of people at highest risk. Athletes, in particular runners or people doing other impact sports, are at risk due to the repetitive loads on the foot. Also people who spend a lot of time standing, particularly on hard surfaces are at risk. The condition can also be linked to weight. 

What are the symptoms?

The pain is usually well localised to the sole of the foot at the back of the heel. Typically people will feel the pain most severely when they first get up in the morning or from sitting down. The pain then tends to ease but comes back during the day after spending longer periods of time standing. 

What is the treatment?

Many different treatments are available for plantar fasciitis. There is no single treatment that works for everyone and many people will try several different treatments.

Physiotherapy is the mainstay of treatment in the early stages. This will involve stretching the calf muscles as well as the plantar fascia. Other treatments include silicone heel pads to protect the painful area and night splints to stop the calf muscle tightening overnight. Steroid injections can be helpful for some people. 

Extracorporeal shockwave therapy is an excellent non-invasive treatment that works in 60-80% of people. This involves at least three sessions, each lasting about 5 minutes. The treatment works by breaking down the thickened damaged areas of the tendon and kick-starting the healing process. 

What about surgery?

Most people with plantar fasciitis will not require surgery. Many people will see significant improvement after the first two months of non-operative treatment. In 80% of people the condition will burn itself out but this can take up to 18 months.

If surgery is required, this is usually carried out under general anaesthetic either as a day case or a one night stay in hospital. Our surgeons use the latest techniques to minimise the disruption of surgery and to accelerate your recovery.

Surgery to the plantar fascia traditionally involved releasing (dividing) the plantar fascia, but more commonly the minimally invasive “TOPAZ coblation” treatment is now used instead. This involves making a series of 1mm holes in the plantar fascia, rather like the top of a pepperpot. This kick starts a healing process in the plantar fascia. If the calf muscle is tight then this can be lengthened through a small incision at the back of the calf. If there is a bony heel spur contributing to the problem then this can be removed by keyhole surgery.

What happens after surgery?

You will usually be able to get home the same day or the day after. You would go home with your ankle either in a moonboot. There will be some swelling and you will find it helpful to keep your foot elevated on a footstool in the early recovery period.

You can walk straight away. If the calf muscle has been lengthened you would have a moonboot which you would wear at night up to the four week mark to prevent the calf muscle tightening up again. 

You would be seen in clinic at the two week mark to check the wounds. After coming out of the moonboot you would start physiotherapy. At that stage you can start to return to lower impact sports such as cycling, swimming and cross training. You can usually start to run between six and twelve weeks depending on the improvement in the pain.

Are there any risks?

All surgery carries risks, and plantar fasciitis surgery is no exception. The surgery can be expected to work in about 80% of people – this means there is a risk you might fail to gain the benefit you expect. The risks will be discussed with your treating surgeon and in particular whether you are at higher than normal risk. These include:

• Recurrence. Occasionally the problem can reoccur.
• Infection. Minor infections are treated with antibiotics and wound dressings. More serious infections can necessitate hospital admission and surgery.
• Blood clots in the legs or lungs
• Ongoing pain
• Persistent swelling
• Numbness
• Nerve related pain