Plantar fasciitis is one of the commonest causes of heel pain, and it happens when the plantar fascia - the thick band of tissue that connects your heel to your toes at the bottom of the foot - becomes inflamed. Characteristically, patients with plantar fasciitis experience stabbing pain in the heel when they wake up and take their first steps in the morning or after sitting for a long time.
The plantar fascia is responsible for supporting muscles in the foot and absorbing shock from movements. However, with overexertion of this tissue can cause numerous microtears resulting in degeneration and inflammation.
Certain groups of people are at higher risks of plantar fasciitis. For example, it is more common amongst avid runners. Other factors that are associated with plantar fasciitis include:
- Age – plantar fasciitis is more common in people aged 40 to 60 years
- Obesity – Excess body weight can put additional stress on your foot
- Occupation – People whose jobs require long hours of standing on hard surfaces are more prone to plantar fasciitis. These include factory workers, sales personnel and teachers
- Footwear – Frequent wearing of high heels or shoes that don’t have adequate support can worsen the tear and inflammation at the plantar fascia
- Flat Feet or High Arched Feet – People with flat feet or high arches may experience additional strain to the plantar fascia from the way they stand and walk
You may need to have a doctor evaluate your foot if your symptoms have been present for 3-6 months, and is severely affecting your lifestyle.
In addition, a medical evaluation may be necessary if your symptoms do not fit the classifical presentation of the condition. Some examples of symptoms that may not be due to plantar fasciitis include:
- If you experience burning pain, numbness and tingling, especially at night
- If your pain worsens with prolonged weight-bearing instead of improving
- If you notice swelling, bruising or skin redness over the posterior heel
- If the onset of the pain was sudden acute and knife-like, especially after a minor injury
The doctor will ask you about your symptoms and examine your foot to assess the location of the pain, and rule out other possible causes of heel pain.
The doctor may recommend conservative treatment strategies as firstline. These include:
- Analgesics to relieve the pain
- Physiotherapy to teach you effective stretching and strengthening exercises that correct underlying factors such as tightness of the calf muscles and weakness of the intrinsic foot muscles. These exercises help to increase the flexibility of the calf muscles, stretch the plantar fascia and strengthen the intrinsic muscles of the foot
- Changing your footwear as tight fitting, improper shoes may exacerbate your foot pain. In contrast, shoes with thicker, well-cushioned midsoles are often helpful in relieving pain
- For patients with flat foot, arch supports that help support the arch of your foot and distribute pressure in the foot evenly may be recommended. Arch supports may be available over the counter, or you may also be referred to make customized orthotics that is individualized to your foot
Usually, heel pain from plantar fasciitis will subside and recover within 6-18 months. However if your symptoms are not improving or are affecting your lifestyle severely, we can offer heel pain treatment options (for pain resulting from plantar fasciitis) including injections and minimally-invasive surgery like the Tenex procedure.
- Injections - Our doctors can offer steroid injections or ultrasound-guided platelet-rich plasma (PRP) injections. PRP is obtained by drawing a small amount of the patient’s blood and centrifuging it to concentrate the platelets. These activated platelets are then injected into the injured or diseased body tissue. This releases growth factors that stimulate the healing of the inflamed portions of the plantar fascia.
- Extracorporeal Shock Wave Therapy - With this non-invasive procedure, shock waves are directed towards the plantar fascia to promote tissue healing. Some slight discomfort might be felt but the treatment takes only about 5 minutes.
- Tenex Procedure - Commonly used in the treatment of tennis or golf elbows, this minimally-invasive surgery makes use of ultrasound imaging to guide a needle-like probe into the inflamed tissue, before releasing high-frequency ultrasound vibrations to break up/debride the diseased tissue causing pain. Tenex is a safe and relatively painless procedure, and is performed as an outpatient surgery.
Contact Precision Orthopaedics for a consultation to see if we can help to alleviate your symptoms from plantar fasciitis!
Dr Seng Chusheng is a Consultant Orthopaedic Surgeon with specialised expertise in minimally invasive foot and ankle surgery, sports and reconstructive surgery, as well as treatment for orthopaedic trauma. Dr Seng holds an MBBS and MMed (Orthopaedic Surgery) from the National University of Singapore, and is a Fellow of the Royal College of Surgeons of Edinburgh, UK (Orthopaedic Surgery).
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