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Plantar Fasciitis/Heel Pain
The plantar facia is a tough band of fibrous tissue that lies over the small muscles of the foot extending from the heel to the forefoot. Its function is to bind the small muscles of the foot together and to brace the arch thus giving structural support to the foot.
A heel spur is a protrusion of bone/bony growth extending from a prominence on the bottom of the heel bone. 12% of people have heel spurs and research has shown that people who have experienced long standing Plantar fasciitis demonstrate a higher incidence of heel spurs than normal. Many practitioners mistakenly refer to pain in the heel as a heel spur, however the presence (or not) of a heel spur is rarely significant in the development of pain in the heel.
Plantar fasciitis is thought to be caused by mechanically degenerative small tears in the muscles of the foot & plantar fascia where they anchor themselves to the underneath surface of the heel bone. This suggestion is supported by histological examinations of surgical biopsy specimens and is widely accepted as being credible. Other suggestions include perifascial oedema (swelling in the fascial area).
The suffix ‘itis’ (meaning: inflammation of) suggests that plantar fasciitis is an inflammatory condition and in many cases there is an inflammatory component however there is an increasing consensus with researchers that inflammation of the plantar fascia is rarely present and therefore the condition should be referred to as plantar fasciaosis (‘osis’ – meaning: disease of).
Symptoms of Plantar fasciitis
Plantar fasciitis(osis) is characterised by pain under the heel particularly when bearing weight directly after a prolonged period of non weight-bearing e.g. getting out of bed in the morning.
The levels of discomfort can vary dramatically from a minor nuisance to virtually immobilising the patient. Typically the condition can persist on and off for a period of several months to a few years and can prove difficult to clear, although in many cases will run a natural course until resolving itself (this may take a year or two)
Pain can occur anywhere under the heel although there is often one spot where pain is focused; if this spot is pressed it will feel very sore. It is rare for plantar fasciitis to cause any visible inflammation or swelling and is often unilateral (affects one foot at a time).
Who gets plantar fasciitis?
Excluding children plantar fasciitis can affect anyone, particularly over 40’s who are overweight and stand for prolonged periods of time, especially when barefoot or wearing thin or hard soled footwear with little support or cushioning. However it can and does affect underweight and sedentary people. More females are affected than males.
Treatment of plantar fasciitis
Treatment consists of:
1 Conservative treatments,
2 Cortisone injection (& conservative treatment),
Conservative treatments (should always be considered first), includes:
Patients should avoid any unnecessary weight bearing activity. It is absolutely essential to avoid prolonged standing. Compliance will ensure greater relief of symptoms than any other form of conservative treatment.
There is compelling evidence that suggests Plantar Fasciitis is more prevalent in people who have tight calf muscles and Achilles tendons. Therefore patients should undertake regular calf and foot stretching exercises.
3. Heel Cup 4. Compression Foot Sleeves
Soft soled and supportive shoes i.e. TRAINERS (not ‘pumps’) to be worn at all times, even around the house. Try to alternate your footwear; do not wear the same trainers every day.
5. Gentle Manipulation/Massage
Gently massage the ‘hot spot’ with baby oil. Alternatively roll the heel over a rolling pin, or a tin of beans (or similar), repeat this several times a day.
5. Night splints
6. Anti inflammatory tablets
Although research suggests plantar fasciitis causes limited (if any) inflammation within the plantar fascia Non Steroidal Anti-inflammatory medication (Ibuprofen)can be of help and should be used.
8. Low Dye Strapping
This form of adhesive strapping is effective in providing an instant improvement for patients with particularly acute and debilitating cases of Plantar fasciitis. The strapping is adhered to the sole of the foot longitudinally from the heel to the forefoot. When applied correctly it braces the foot preventing the arch from lengthening when bearing weight, thus protecting the plantar fascia from tension. The strapping will remain taught and secure for several days despite daily baths / showers. Patients can be provided with tape and shown how to apply the strapping themselves.
Low Level Laser Treatment uses infra-red light to:
1. Reduce inflammation 2. Enhance wound healing 3. Stimulates tissue regeneration.
This treatment is completely safe & painless, has no side effects, and is highly effective for Plantar fasciitis. A course of treatment involves up to 12 sessions at the rate of two sessions per week.
Patients will begin to notice improvements after 3 – 4 sessions of laser treatment and can then expect significant relief of symptoms after a course of up to 12 sessions. A course of up to 12 sessions costs £195.
The majority of patients who persist diligently with the conservative treatments listed previously can expect an improvement in symptoms.
However where significant symptoms do persist (after 4-6 weeks of conservative treatment) then consideration should be given to an injection of cortisone.
Patients can be reassured that at this practice these injections are quite painless as the foot is numbed with a local anaesthetic (Tibial Nerve Block) prior to the injection of cortisone solution.
In accordance with recommended best practice we audit all outcomes for Cortisone injections. We achieve exceptionally high rates of cure for Plantar Fasciitis with these injections (since 2009 we have achieved cure rates of 95%). The cost of a cortisone injection is £160 which includes two follow up review appointments.
You don’t need to tolerate the persistent misery of Plantar Fasciitis!
Call today and allow us to put our vast expertise into action. It is highly probable that we can cure your heel pain.
“Hollinshead & Associates have provided excellent service in caring for my feet. In particular a long standing problem of pain in my right foot (Plantar Fasciitis) has been completely cured by a steroid injection delivered painlessly after a local anaesthetic. The staff Mark and Sarah plus the women on reception are most caring, considerate, and professional”.
Mrs J Pilton, Northwich.