The Plantar Fascia is a strong band of ligamentous tissue in the sole of the foot. This ligament originates from the heel and runs forwards in three bands: Medial, central and Lateral bands to insert into the bases of all the toes. The Plantar fascia frequently becomes inflammed and the condition is then known as Plantar Fasciitis. The inflammation may occur at the origin of the Plantar Fascia, where it joins the heel bone or it can also occur within the arch of the foot. The fascia may also become degenerated and this would be termed Plantar Fasciosis.
The most common cause of Plantar Fasciitis is abnormal foot mechanics e.g abnormal pronation. There are however many other causes: obesity, trauma to Fascia, poor footwear, overuse, systemic diseases.
The symptoms of Plantar Fasciitis are: pain which is usually worse after rest (post static dyskinesia), pain in centre of heel, pain radiating along arch of foot, throbbing pain in heel at night in bed.
Diagnosis is made by clinical history and use of an Ultrasound scan
Treatment of Plantar Fasciitis
In the early stages a programme of stretching exercises, the use of ice, stretching the fascia before standing and oral anti inflammatories, is often successful in reducing pain. If after 6 weeks the pain persists then you may wish to consider the use of orthoses and or cortisone injections. The effectiveness of injection therapy can be enhance by having the injection carried out under Ultrasound guidance and this is performed at the joint pain clinic. Patients may find injections uncomfortable.
Many patients may not wish to consider injection therapy and may instead elect to have Shockwave therapy ESWT.
Before commencing a course of ESWT patients must have had an ultrasound scan confirming the diagnosis of Plantar Fasciitis. The treatment consists of three sessions of ESWT at weekly intervals. TheESWT is a relatively painless treatment with only very mild discomfort experienced by the patient. Patients are able to return to work and drive if they feel able to do so immediately after treatment. Side effects are minor: redddening of area, bruising and paraesthesia.
ESWT is an effect treatment for Plantar Fasciitis. It is recommended by NICE provided an ultrasound scan confirms the diagnosis and the treatment outcomes are audited.