Plantar fasciitis

The plantar fascia is a tendon-like band of tissue which stretches from the heel to the toes. It acts a shock absorber and supports the arch of the foot. Plantar fasciitis is a condition characterised by pain felt on the underside of the heel. It is particularly severe first thing in the morning or when getting up from a period of rest. It can be caused by a variety of factors including abnormal strain on the arch of the foot, poor footwear, altered biomechanics of the foot or direct trauma. Tightness of the calf muscles, gastrocnemius and soleus, is usually a major contributory factor which prevents the fascia from healing.

The condition is usually self-limiting but can take up to two years to resolve. Treatment is aimed at altering the environment of the fascia to promote healing. This almost invariably requires a good programme of eccentric stretching exercises for the calf muscles perhaps combined with insoles. It may be augmented by an x-ray guided steroid injection or extra-corporeal shock-wave therapy to reduce pain and facilitate healing. A gastrocnemius muscle release is often effective for the small number of people who do not respond to non-invasive techniques.