Plantar Fasciitis

What is plantar fasciitis?

Plantar fascia is a thick band of connective tissue which runs along the sole of your foot, from the heel through to the forefoot. Plantar fasciitis is a term used to describe pain and inflammation stemming from the plantar fascia attachment site at the heel.

In recent years, the term plantar fasciitis has been used less and less frequently, with many clinicians utilising the term ‘plantar heel pain’ instead. This is due to evidence suggesting there are usually multiple tissue sources implicated in presentations of heel pain which are difficult to differentiate.

Furthermore, the suffix ‘-itis’ in plantar fasciitis suggests that this issue is inflammatory in nature. We know that the pain emanating from the plantar fascia is not usually the result of an inflammatory process. For this Q&A, we’ll be using the term plantar fasciitis to describe plantar heel pain.

What causes it?

The development of plantar fasciitis is varied, complex and multifactorial.

A common contributing factor to the onset of symptoms is an acute increase in activity levels or time spent on their feet. For others, there may be no obvious change in activity levels preceding the onset of symptoms, These individuals often have risk factors related to their lifestyle, biomechanics and local tissue capacity. 

Do orthotics help?

There is no evidence to support the use of orthoses in the management of plantar fasciitis.

A common misconception is that orthoses are a ‘major bullet’ fox for plantar heel pain. However, there is no string evidence to support the use of orthoses in isolation.

Good long term outcomes require a multimodal approach which also target risk factors for the development of symptoms in the first place.

How do I treat it? 

There are many treatments available for plantar fasciitis.

We usually begin management with a ‘core approach’, which includes education around load management, footwear and weight management. We may also prescribe plantar fascia stretching exercises and demonstrate taping techniques. 

For cases which do not respond to core approach strategies, shockwave therapy and orthoses may add further benefit.

I’ve already had my heel pain for 3 months. How long will it take to get better?

It’s difficult to say in your case without assessment. One of the biggest challenges with this condition is it’s long prognosis.
Overall, long term outcomes are generally good with effective management. One particular study suggests that 80% of individuals will have a resolution of symptoms within 12 months.

Individuals with poorer overall health (ie. high BMI, poor sleep quality, health conditions such as diabetes and high stress) are more likely to have poor outcome or prolonged recovery.