In my practice I see lots of people with plantar fasciitis (it affects about one in ten of the population). For some, it's a bit of a nuisance; for others, the pain is so great it stops them from getting on with their daily routine.
What is it?
There's a pad of fibrous tissue and fat - the medical term for this combination is fascia - that runs from the heel to the ball of each foot. This pad reinforces the action of ligaments in maintaining the shape of the foot, in particular the arches.
Repetitive activity or overuse of our feet causes this pad to stretch. Sometimes when this happens, small tears appear in the pad, which become inflamed. This usually happens near or at the point where the pad is attached to the heel, which is why it feels painful.
Who gets it?
Plantar Fasciitis is particularly common among sportspeople and others who are on their feet a lot (it's also known as jogger's heel, tennis heel and even policeman's heel). But other important factors include wearing high heels (not often the cause for men) and suddenly becoming more active for one reason or another (or changing the type of exercise you do). It also tends to occur more often as people get older, and being overweight makes it more likely, too.
Years ago, the pain was thought to be caused by the growth of bone from the bottom of the heel bone called a heel spur. This is sometimes the case, but it's usually inflammation that's to blame; when people with plantar fasciitis have an x-ray of their heel, there's often no spur to be found.
Help yourself
Given time, plantar fasciitis gets better on its own, especially if you're able to stay off your feet long enough. Realistically, though, long periods of rest are a thing of the past and (quite understandably) people want to get on with their lives.
One of the most effective things you can do is to carry out a series of stretches on your feet. You will need advice from a physiotherapist to show you how to do these - and you need to do the stretches for at least 15 minutes, five times a day for them to work. You should stretch them out when you wake each morning before first footfall (that is, before you take any weight on your feet), and then again throughout the day. Pain is often worse when you first walk in the morning because the tendons, including the Achilles tendon in the leg, tend to contract during the night pulling the foot downwards. You may be surprised how just a few minutes of stretching the feet upwards can ease the pain.
Putting a foam ring support in the heel of the shoe can also help to keep the pressure off the painful area. These can be home-made or bought from a pharmacist. To relieve the pain, put your foot on a cold pack (a bag of frozen peas wrapped in a tea towel will do), or on a heat pack also wrapped in a towel, for a few minutes three or four times a day.
Arnica cream and witch hazel solution are good natural anti-inflammatory treatments. Paracetamol and ibuprofen work well to relieve the pain, too. Some people benefit from acupuncture, while others are helped by physiotherapy with ultrasound therapy. Steroid injections can be used, but usually only once other treatments have failed.
The condition often tends to resolve on its own - but it may take 12 to 18 months to do this, and some people have long-term complications such as distortion of the structure of the foot. Once the problem is resolved, it's important to make sure it doesn't come back. This means losing weight (if necessary), continuing a programme of daily stretches and seeing a qualified chiropodist, who can advise on shoe orthoses to correct the shape of your foot.
This article was last medically reviewed by Dr Trisha Macnair in June 2008
