Plantar Fasciitis

Introduction

Plantar fasciitis is one of the most common causes of heel pain.

It involves inflammation of a thick band of connective tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning or after a period of inactivity.

The pain typically lessens with gradually increased activity, but worsens toward the end of the day with prolonged weight bearing.
The sensation of the bottom of the heel is quite painful, and the patient may complain of a burning sensation.

Peak incidence at age 40-60 years old
Certain types of exercise, such as long-distance running, ballet dancing and aerobic dance
Flat feet (pes planus)
Obesity
Prolonged walking or standing on hard surfaces

Provision of education about the condition including its possible causes.

Patients may have unrealistic expectations that medical care can eliminate the pain.

Initial measures include

Avoiding the use of flat shoes and barefoot walking
Use prefabricated, silicone heel shoe inserts (arch supports and/or heel cups)
Decreases physical activities that are suggested by the medical history to be causative or aggravating (e.g. excessive running, dancing or jumping)
Prescribing paracetamol or a short-term trial (2-3 weeks) of NSAIDs
Injecting the tender areas of the plantar region with glucocorticoids and a local anaesthetic.

In patients without sufficient improvement from initial measures, more costly therapies can be considered, although these remain unproven:

Surgery is generally reserved for those patients who do not respond to at least 6-12 months of conservative therapy, but it is also unproven.