Plantar Fasciitis: Causes, Symptoms, Diagnosis and Treatment

Plantar Fasciitis Anatomy

The Plantar Fascia is a thick fibrous band of connective tissue on the underside of your foot. The origin of the Plantar Fascia is the inner (medial) side of the heel bone and spreads out like a fan to attach across the underside of the forefoot. The Plantar Fascia is a passive structure so unlike a muscle, it is not able to actively contract. It provides stability to the medial arch of the foot which means that it is under constant tension in a standing position. Another important function of the Plantar Fascia is its role in the windlass mechanism. As the toes are extended it places tension on the Plantar Fascia, which in turn acts as a stabiliser on the arch of the foot. This is a key function in the push-off phase of the gait cycle.

If the Plantar Fascia becomes overloaded through excess use, it can become painful and is then referred to as Plantar Fasciitis. We plan to discuss everything around Plantar Fasciitis in this article including the causes, symptoms, treatments and FAQ.

Plantar fasciitis diagram

Plantar Fasciitis Causes

The plantar fascia is a non-contractile tissue. Unlike a muscle, its primary function is to provide stability to the underside of the foot and the medial longitudinal arch (MLA). When walking, running, or hopping the plantar fascia absorbs force and stabilises the foot.

If the Plantar Fascia becomes overstretched or irritated from overuse or through an overload such as a sudden change in activity levels, it can result in inflammation and pain of the Plantar Fascia.

Risk Factors for Plantar Fasciitis Include

Sudden Changes in Activity Levels
Repetitive overload of the Plantar Fascia
Poor Footwear
Foot deformity
Obesity
Age: Plantar fasciitis is more prevalent in 40-60-year-olds
Heel Spurs are not a cause of Plantar Fasciitis despite a long-held belief by many that they are.

Plantar Fasciitis Symptoms

Plantar Fasciitis is most often associated with pain in the inner aspect of the heel bone (Calcaneus) during weight-bearing activities such as standing, walking, hiking, or running. This pain may extend into the arch of the foot. This is known as a non-insertional plantar fascitis but should not be confused with Posterior Tibial Tendonitis.

Plantar Fasciitis’ most common symptoms are pain and stiffness first thing in the morning when stepping out of bed. This generally eases after 5-10 minutes of walking but in more severe cases this pain may persist for longer. A similar sensation may occur when standing and walking after sitting for a long period of time.

Plantar Fascia pain is associated with movement and is often worse at the start of an activity such as walking or running but as circulation increases in the area through activity, pain levels may decrease before returning in the hours after exercises. As symptoms deteriorate in more chronic cases, pain may not ease but get gradually worse.

Pain should subside in non-weight-bearing positions, if it doesn’t and the pain is keeping someone up at night, it is important to consider what other conditions may be causing similar symptoms to Plantar Fasciitis. It is uncommon to have pain in the forefoot with Plantar Fasciitis.

Picture of a person pointing to plantar fasciitis

Other Conditions Causing Heel Pain

Calcaneus Stress Fracture
Posterior Tibial Tendonitis
Peroneus Longus Tendonits
Calcaneus Fat Pad Atrophy
Calcaneus Bursitis
Baxters Nerve Entrapment
Flexor Hallucis Longus Pain

Diagnosis

A diagnosis of Plantar Fasciitis is achievable through a consultation with a medical professional such as a Sports Medicine Doctor or a Physical Therapist. A careful, thorough clinical interview should be carried out to determine the exact time of onset, definitive symptoms, and potential causes of the plantar fascia pain.

This should be followed by a clinical examination of the foot position, gait, strength, and mobility of the entire lower limb. The therapist will apply pressure to the medial aspect of the calcaneus and if this is painful, then the likelihood is high that Plantar Fasciitis is present. Clinical tests should be carried out to rule out all other conditions that can cause similar symptoms such as a calcaneus stress fracture.

Imaging can be helpful to confirm the diagnosis. High-frequency ultrasound is useful to identify any thickening of the Plantar fascia along with any inflammatory signals. An MRI may be requested to provide a more in-depth picture of the plantar fascia and the surrounding areas of the foot and ankle. X-rays or CT scans are rarely used as they cannot diagnose Plantar Fasciitis.

Picture of Ultrasound Scan Plantar Fasciitis

Plantar Fasciitis Treatment

Treatment under the guidance of a Physical Therapist is highly recommended for this condition as it is complex to manage and requires a combination of different treatment strategies to recover from Plantar Fasciitis. In this section, we are going to explore the various treatment methods currently available to us.

Plantar Fasciitis Home Remedies

Off-the-shelf insoles are effective at reducing pain levels in Plantar Fasciitis. Lee et al, 2012, found that the use of insoles alongside night splints provided more pain relief than either on their own.

Self-massage tools such as a tennis ball, foam roller, massage gun or Plantar fasciitis socks can provide immediate relief but are often temporary.

A tens machine provides effective pain relief while it’s being used and Voltaren gel is a good localised anti-inflammatory but it is important to let it dry in completely before covering the foot with clothing.

Plantar Fasciitis Treatment for Pain Relief

For moderate to severe symptoms of Plantar Fasciitis is can be too painful to walk let alone carry out strengthening exercises. In these instances the following modalities can help reduce pain levels:

Plantar Fasciitis Massage can relax the tissue and surrounding muscles and is often complemented with Plantar Fasciitis stretches to elongate the calf muscle.

Acupuncture or dry needling can be used for pain relief which involves thin needles placed along energy lines of the foot and ankle.

Plantar Fasciitis Taping may be used to shorten the Plantar Fascia with zinc oxide being the most effective of these as it is rigid and durable. KT Tape has a minimal benefit for Plantar Fasciitis.

Physical Therapy

Strengthening Exercises are the most effective form of treatment for Plantar Fasciitis. It helps by conditioning the Calf Muscles and Plantar Fascia to tolerate more force when exercising.

These should become progressively difficult through adding more weight and may then progress into a plyometric program

A Gait Analysis and running gait analysis are beneficial to identify are biomechanical issues that may be causing an overload of the Plantar Fascia and this is where custom insoles may be required for more complex foot conditions that off-the-shelf insoles don’t accommodate.

Shockwave Therapy For Plantar Fasciitis

Extracorpeal shock wave is a form of treatment that is moderately effective for Plantar Fasciitis and it can be used alongside strengthening exercises.

By sending acoustic waves through the tissue it is believed to have an effect on sensory fibres leading to an analgesic effect.

There is minimal downside to having this treatment and it is available in public and private health settings.

Steroid Injection for Plantar Fasciitis

Steroid Injections has demonstrated good effecitives in reducing pain levels in Plantar Fasciitis.

It’s effectiveness appears to last for 1 months on average. However, it comes with an increased risk of Plantar Fascia rupture and/or fat pad atrophy.

To reduce these risks, the injection should be performed ultrasound guided by an experienced Physician.

PRP for Plantar Fasciitis

There is some emerging evidence to suggest that PRP is as effective in providing pain relief as a steroid injection for Plantar Fasciitis but with longer lasting benefits.

However, we await further studies and it is rarely covered by public or private healthcare companies.

Surgery for Plantar Fasciitis

Plantar Fasciotomy involves the surgical release of 2/3 of the Plantar Fascia. This should be considered a last resort and while there is some positive results we are awaiting high level studies to confirm its effectiveness. It is normally followed by a period of time in a boot before recommencing Physical Therapy.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.