Plantar fascitis and heel pain
What is plantar fascitis (PF) and heel pain?
Plantar fascitis (PF) is an inflammation of the insertion of the plantar fascia into the heel bone and along the length of the arch. Heel pain may be related to other conditions like stress fractures, nerve entrapment and inflammatory conditions.
The plantar fascia is a thick band of tissue that spans the arch of the foot from the heel bone to the bases of the toes. The function of this tissue is to contribute to the support of the arch of the foot. The plantar fascia has an important role in foot mechanics after the heel comes off the ground and as the foot propels the body forward.
There is an indirect relationship between the plantar fascia and the Achilles tendon. The plantar fascia tightens when the toes are dorsiflexed (flexed up). If tension is then generated in the Achilles tendon, it will increase the strain in the plantar fascia.
Although a heel spur may be identified on an X-ray, it remains unclear whether this spur contributes to the pain. Up to 15% of the normal asymptomatic adults have a calcaneal spur, and about half of those suffering from heel pain have spurs on x-ray.
The fact that many people with this type of spur have no pain, and that removing the spur often does not relieve the pain in patients with heel pain, casts doubt on its role as a cause of the discomfort.
What are the symptoms of plantar fascitis?
If you notice these symptoms, consulting a specialist can help address the condition and prevent it from worsening.
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Painful heel
- Tenderness on the bottom of the heel when you touch the foot to the ground. Usually, the heel is painful as you step out of bed.
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Inability to stand for a prolonged period
- Discomfort around the heel, especially when standing for a long time. The heel may also be painful after a long walk.
Will my pain improve without surgery?
Plantar fascitis is self-limiting in most sufferers, with many resolving in twelve to eighteen months.
Risk factors for developing plantar fascitis include older age (peak age is between forty to sixty, as the heel fat pad begins to lose its shock-absorbing capacity) and an increase in body weight.
Abnormal foot mechanics and flat feet, tight Achilles tendon, intensity of daily activity (with walking, the heel absorbs 110% times body weight, and with running, this increases to 200%), repetitive heel trauma (e.g. runners) and those who stand for much of the day are also at risk of developing plantar heel pain.
In up to 1/3 of patients, the symptoms occur in both feet, and medical conditions like diabetes and inflammatory arthritis can contribute to the increased risk of developing heel pain.
Nonoperative management of plantar fascitis
It is advisable to persist with non-operative management of plantar fascitis for as long as you are able to manage the symptoms.
Stretching
Evidence suggests that a specific stretching programme for the plantar fascia and Achilles tendon can give lasting relief from symptoms. A physiotherapist can help design a specific stretching programme for both the plantar fascia and Achilles tendon.
Orthotics
There is fair evidence to support the use of orthotics in the short-term relief of plantar fascitis. A soft, flexible orthotic with a deep heel cup and plenty of soft cushioning under the affected area is the most suitable. An ‘off-the-shelf’ orthotic can be used initially, and if relief is obtained, a custom-made orthotic may be appropriate. Shoes are important for providing support and cushioning. A podiatrist can be helpful in suggesting shoes that may be appropriate.
Anti-inflammatory medication
Anti-inflammatory medication may alleviate some of the symptoms of plantar fascitis, but not in all patients.
Corticosteroid injection
A single cortisone injection helps relieve symptoms but repeated steroid injections may be harmful to the local tissue.
PRP - Platelet-rich plasma injection
This treatment with platelets obtained from your blood sample, which is centrifuged to a concentrate (full of growth factors), seems to be showing promising results in the literature. The procedure is offered at radiology practices around Adelaide.
The injection may be painful, but worthwhile trialling alongside other treatment modalities.
Extracorporeal shock wave treatment
There is conflicting evidence supporting the use of extracorporeal shock wave treatment for plantar fascitis, but it remains a modality of treatment offered by the physiotherapist. It may work in conjunction with other treatments.
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With multiple clinic locations across Adelaide, we offer immediate availability, often seeing patients within 24 hours of receiving a referral.
Advanced care for your condition
Our specialised procedures, including advanced surgeries like ankle fusions, prioritise quicker recovery and less discomfort.
Foot and ankle specialist surgeon
Unlike general practices, we specialise exclusively in foot and ankle conditions, ensuring you receive expert care tailored to your specific needs.
Tailored treatment plans
We thoroughly assess your needs and present personalised treatment options, including non-surgical solutions where appropriate.
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We take the time to explain your condition and treatment options, ensuring you’re fully involved in every decision regarding your health.
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For most operations, your gap paid to the practice is the only out of pocket cost for surgery, without additional or hidden costs. There is a separate gap payable to the anaesthetist and the surgical assistant who work alongside, but independently of Dr. Silveira.
* Complex procedures may attract additional costs that will be discussed with you at the initial consultation.
Meet Dr Gayle Silveira, the surgeon behind your care
Gayle Silveira is a fellowship-trained foot, ankle and trauma surgeon. She completed Orthopaedic training in Adelaide and is a Fellow of the Royal Australasian College of Surgeons.
Gayle gained further experience in complex surgical techniques through advanced training in foot and ankle surgery under the guidance of Dr. Simon Platt. She is proficient in keyhole surgery/minimally invasive techniques and management of sports injuries. In addition, her Master’s in Biomechanics and Sports Physiology complements her expertise in foot and ankle pathology.
Gayle is committed to offering her patients high-quality care with compassion and respect. She spends time listening to you whilst carefully formulating a tailored management plan. Her goal is to help you achieve your desired outcome.
Fellow of the Royal Australasian College of Surgeons (Orthopaedics)
Member of the Australian Foot and Ankle Society
Bachelor of Medicine and Surgery
Master's Sports Studies (Biomechanics and Sports Physiology)
Member of the American Foot and Ankle Society
