Plantar fasciitis

What is plantar fasciitis?

Also known as jogger’s or policeman’s heel, plantar fasciitis is one of the most common sources of heel pain.

It occurs when the plantar fascia – the connective tissue that supports the arch on the bottom of the foot – is inflamed, torn or broken down.

The plantar fascia is a thick, fibrous band of connective tissue that runs along the sole from the heel to the ball of the foot. It keeps your bones and joints in position, and helps you push off from the ground.

Bruising or overstretching this tissue can cause inflammation and heel pain. Plantar fasciitis is often associated with heel spurs, but the spur itself does not cause pain and can often be found in the other foot without symptoms.

Symptoms of plantar fasciitis

Plantar fasciitis symptoms include:

• Heel pain after, but not during, exercise
• Heel pain after long periods of standing or after getting up from a seated position
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs, or when standing on tiptoe
• Mild swelling in the heel
• Sharp pain in the inside part of the bottom of the heel, which may feel like a knife sticking into the bottom of the foot

Causes of plantar fasciitis

Plantar fasciitis is an injury that seems to appear overnight for no apparent reason. It is, however, caused by either a traction or compression injury.

A traction injury occurs when the plantar fascia is repeatedly overstretched, the most common reason for which is an elongated arch due to poor foot biomechanics (over pronation) or weakness of the foot arch muscles.

Compression-type injuries involve trauma – for instance, landing on a sharp object that bruises the tissue – and pain further under the arch than the heel.

You are more likely to develop plantar fasciitis if you are:

• Active – aerobics, ballet and running, for instance, place stress on the heel bone and attached tissue
• Arthritic – some types of arthritis can cause inflammation in the tissue, which may lead to plantar fasciitis
• Diabetic – plantar fasciitis occurs more often in people with diabetes
• Middle-aged or elderly – with ageing, the arch of the foot begins to sag, placing extra stress on the plantar fasciitis
• On your feet a lot – factory, hospitality and teaching work, for example, requires standing and walking on hard surfaces for much of the day
• Overweight – carrying extra weight increases strain and stress on the plantar fascia
• Pregnant – swelling and weight gain associated with pregnancy can cause the tissue to relax, leading to mechanical problems and inflammation
• Someone with flat feet, high foot arches or weak foot arch muscles

Diagnosis and treatment of plantar fasciitis

Plantar fasciitis is usually diagnosed by a general practitioner, physiotherapist or sports doctor based on symptoms, clinical examination, and history. Tests may include:

• X-rays – to reveal calcification within the plantar fasciation, which is known as a heel spur
• Ultrasound scans and MRI – to identify any plantar fasciitis tears, inflammation or calcification
• Pathology tests (including screening for the HLA B27 antigen) – to identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis

Plantar fasciitis is reversible and successfully treated – about 90% of Australians with plantar fasciitis improve significantly within two months. The most common treatment methods include:

• Ice – applied onto the heel area for around five minutes
• Rest or reduced activity – refraining from standing for long periods, walking, running, sports
• Cortisone-steroid injections – into the heel bone
• Orthotic insoles – to correct poor foot biomechanics
• A program of daily exercises

Further information and sources

• Health Direct Australia
• Sports Medicine Australia