114 Heel Pain V3

Heel Pain
Caused by Plantar Fasciitis

What is Plantar Fastiitis?
Plantar fasciitis (also known as plantar fasciopathy) is a
common cause of pain under the heel and sometimes
into the arch of the foot. It is caused by excessive load or
stresses through the foot, which can result in a thickening
and structural changes to the plantar fascia. The plantar
fascia is a “ligament” type structure which helps to support
the arch of the foot and acts as a shock absorber. It
connects the heel bone (calcaneus) to the ball of the foot.
What are the symptoms?
The main symptom of plantar fasciitis is pain in the heel,
across the sole of the foot (the part that touches the
ground) and sometimes it can spread into the arch area of
the foot too. The pain can be described as sharp, burning and aching. The pain is usually worst
when you first place weight on your foot, for example, when you get up in the morning or after
long periods of sitting. The pain can worsen as the day goes on and/or after long periods of weight
bearing such as standing or walking for a long time. It can feel as though the more you do, the
worse the pain gets.
Why did I get it?
Plantar fasciitis can affect anybody, but it is most common amongst people over the age of 40 and
it can affect both athletic and non-athletic people. There are many theories as to the development
of the condition, these include: over using the ligament by doing too much standing/walking,
excessive body weight and altered biomechanics e.g. people with flat feet or high arched feet or
those with tight calves causing limited upward movement of the ankle). Occupations that require
extended periods of weight bearing i.e. those that work shifts of eight hours or more, are also
linked with the development of plantar fasciitis
How is Plantar Fasciitis treated?
Plantar fasciitis is thought to be a self limiting condition, which means it will generally resolve by
itself. Normally this can happen within about 18 months. Around 80-90% of patients will get better
with simple interventions, such as stated below. Its important to be patient with some of these
treatments as they might take a while to work.
Stretching and Insoles
Clinical research shows that many people (often around 80%) will respond well to simple
treatments. These can include stretching of the calf muscles and the wearing of cushioning
insoles. Avoiding any barefooted walking can help treat your symptoms. Your practitioner can
advise you further on these treatments options.
Ice and Activity Modification
Since the condition is often due to an overload of the ligament, a reduction in certain “impact”
type activities, such as running, may be required for a specified time. Applying ice to your heel for
First choice for orthopaedic care Version 114/03 Review: November 2022
www.roh.nhs.uk | 0121 685 4000 Page 1
Heel Pain
between 5-10 minutes once or twice a day after a period of activity can help reduce any swelling
and may ease your symptoms.
Footwear
Poor footwear has been found by several studies to cause plantar fasciitis. Therefore, it is
important to evaluate your current footwear and, if necessary, change your regular footwear to
something more suitable. Footwear should be supportive, not compress the foot, fit well and have
soft inserts. High heeled shoes may lead to tightening of the calf muscles, which can aggravate
this condition.
Night Splints
Night splints are basically an extension of stretching as they both work on the same principal.
However, a night splint is worn for longer periods, applying a constant stretch to the plantar fascia.
Ideally they should be worn all night, but this is often impractical. If they can be worn for periods
of 15-30 minutes at a time, several times a day, then this should have a similar effect. However,
these can take some getting used to and they do need to be worn for some time before any
beneficial effects are experienced.
Weight-Loss
There is strong evidence that being over-weight can be a cause of heel pain. If you are
overweight, weight-loss can be an important part of this treatment plan. Your practitioner and or
GP will often be able to refer you on to a weight loss programme. As such, don’t be surprised if
weight loss is discussed as part of your consultation.
So what happens next?
In the first instance you should give these first line treatments 6 to 12 weeks to have an effect.
If you are getting improvement, you should continue these treatments until the symptoms have
resolved. If however, these treatments do not give you satisfactory improvement, then other
treatment options may be initiated by your practitioner. These may include some of the following:
• Injection therapy (such as a steroid injection) into the heel.
• Functional orthoses (insoles designed to alter the forces under your foot.)
• Immobilisation of the affected foot (using a special boot.)
• Shockwave therapy - this is a relatively new treatment for patients with longstanding heel pain.
It involves the application of energy waves to the affected part. More information can be found
online at: www.nice.org.uk
• Surgery - It is rare that surgery is considered for this condition.
SPECIAL NOTE
It is important to note that heel pain can be caused other conditions such as certain types of
arthritis or may even be due to referred pain from your back. Therefore, it may be necessary to
refer you to another health practitioner if the condition doesn’t resolve or if another cause to your
foot pain is suspected.
First choice for orthopaedic care Version 114/03 Review: November 2022
www.roh.nhs.uk | 0121 685 4000 Page 2

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Heel Pain

Caused by Plantar Fasciitis

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