Plantar fasciitis is the most common cause of pain felt underneath the heel in adults. It us usually most severe when first getting out of bed in the morning or getting up from a period of sitting down. The plantar fascia is a strip of tissue that runs from the heel bone under the arch of the foot to reach the toes. It is crucially important to the mechanics of the foot as it holds up the arch of the foot and enables us to walk efficiently on just two legs.
The causes of plantar fasciitis are not well understood, but it is more common in people who are middle aged, overweight, have very flat or high arched feet and who have tight calf muscles. It is not caused by heel spurs.
The diagnosis may be made clinically by history and examination and confirmed by MRI scan if there is doubt. Other possible causes of heel pain that may be confused with plantar fasciitis include stress fractures of the heel bone (calcaneum) or nerve entrapment.
Plantar fasciitis does not usually require surgery, and the majority of cases resolve within a year without an operation. The key to treatment is a dedicated programme of exercises to stretch out the calk muscles, especially gastrocnemius; this may be more effective if it is combined with calf strengthening exercises. Other treatments, such as extracorporeal shock wave therapy and injection of steroids or protein rich plasma under x-ray or ultrasound guidance, may aid recovery, but are not substitutes for a proper eccentric stretching regime.
There is little evidence that rolling a can of coke or similar object under the foot or taking anti-inflammatory drugs are helpful, but some people may feel benefit from these measures.
If the plantar fasciitis does not respond to non-surgical management, an operation may sometimes be needed. Surgery to release the inner side of the fascia can be of benefit, but, if it is still tight, a release of the medial head of the gastrocnemius muscle in the calf may provide more reliable relief of pain with a lower risk of complications.