Plantar Fasciitis

This page describes the condition of Plantar Fasciitis and the approach to this condition adopted by Mr Bowyer at Spire Southampton. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.

Description
Plantar fasciitis is an annoying and painful condition that limits function. There is pain and tenderness in the sole of the foot, mostly under the heel, with standing or walking. The condition often comes on gradually, without any clear incident or injury. In others there may be a history of sudden increase in sporting activity, change of footwear, sports shoes or running surface. The plantar fascia is a dense fibrous structure which originates from the heel bone, and runs to the ball of the foot. The plantar fascia stiffens and becomes less pliable with age.

The pain is often worse when first getting up in the morning, with hobbling downstairs, or when first getting up from a period of sitting – the typical start-up pain and stiffness. The pain can at times be very sharp, often changing to a persistent background ache.

Initial Treatment
Rest can be helpful in settling the condition in the early stages, with anti-inflammatories either as tablets or applied as a gel. There is an important role for the stretches and massage; self-help advice sheets are available with stretching exercises and advice on the use of massage, foot rollers, ice etc.

Patients might expect (or dread) an injection in to the plantar fascia. There is some controversy around this; it can be carried out without excessive pain, but results are mixed.

A physiotherapist can help with a regular stretching regime for 8-12 weeks, supplemented with local massage (for instance with a foot roller). Assessment of the foot by a podiatrist can identify and correct predisposing factors such as flat foot.

Cases that do not settle
There are some conditions in the foot and ankle, Achilles tendonitis and plantar fasciitis in particular, which are difficult conditions to treat, and the symptoms and disability often seem to persist despite appropriate early treatment – they are problems for the patient and the orthopaedic surgeon alike!

A relatively new treatment, Extracorporeal Shockwave Therapy (ESWT) or lithotripsy, has been successful in many cases. The National Institute for Health and Clinical Excellence (“NICE”, sometimes called the health watchdog) has looked at the procedure in detail, and approved its usage in certain circumstances.

The treatment is carried out in the outpatient department which has the special equipment, there is no need for anaesthetic, and each treatment session lasts 5-10 minutes.

ESWT is non-invasive – no cuts are made and no needles are used. A gel is applied to the skin over the painful area, and the impulse device is pressed against the area and small shock waves are generated. A treatment session lasts about 5 – 10 minutes.

for more information on ESWT Click here