Emergency and Urgent Care - Plantar Fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is a painful condition to the sole of the foot caused by repetitive strain of the plantar fascia. This is a fibrous band of soft tissue connecting your calcaneus (heel bone) to the head of the metatarsal bone and proximal phalanges of your toes. It helps to reinforce the arch of your foot and acts like a “bow string” to stiffen your foot when you walk.

Plantar fasciitis is a relatively common condition that affects approximately 1 in 10 adults. It can affect both athletes and non- athletes; tends to be more common in people whose occupation involves standing on hard surfaces for long periods of time, and those who participate in sporting activities such as long distance running.

Risk of developing Plantar Fasciitis:

Many things affect the load being put through your plantar fascia; these include:

• Age – it is more common in 40 – 60-year-olds
• Gender – it is more common in women than men
• Weight – you have a higher risk of developing it if you are overweight
• Diabetes – people with diabetes are more likely to develop plantar fasciitis
• Flexibility – reduced ankle movement can increase the risk
• Foot type – it is more common in people with a high arched foot
• Footwear – old or poor-quality footwear can also increase the risk

Symptoms of Plantar Fasciitis:

The most common symptoms are:

Variable pain – pain is felt around the heel bone, most commonly on the sole of the foot. People often complain of “first step” pain when they first get up in the morning, this usually improves throughout the day and with exercise, but is worse at the end of the day or after a lot of activity. Some people experience severe pain which may cause a limp and stop them from doing their activity/sport.

Morning stiffness – many people complain of stiffness around the heel bone when they first get up, this eases after a few minutes of walking, but may last longer.

Tenderness – often the underside of the heel is tender when pressed. Usually there is one particularly tender spot, but sometimes it can be generalised tenderness.

Treatment Options:

Ice – applying ice wrapped in a damp tea towel for 20 minutes, 4 times a day, or after exercise can help to reduced pain. Please take not to apply the ice for too long or directly onto the skin, as this can cause ice burns. Do not apply ice packs to an area where you have numbness, decreased sensation or poor circulation.

Painkillers – a short course of paracetamol or ibuprofen for a few days can be helpful. Always read the instructions on the packet and do not exceed the recommended dose.

Relative Rest – you can help to maintain your fitness doing different types of exercise that do not significantly aggravate your symptoms such as swimming, cycling. Try to adjust your work pattern to avoid long periods of standing and have regular breaks.

Home exercises – see further details in this leaflet.

Footwear – supportive footwear with a stiff outer sole and a shock absorbing inner sole.

• Wear footwear that has arch supports and cushioning for your heel
• Avoid wearing flip flops or walking barefoot
• Maintain your shoes in good condition and renew your trainers every 300 to 500 miles. Consider having 2 pairs of trainers on the go if you are a runner and alternate which pair you wear

Manage your weight – if you are overweight, see your GP for strategies to manage your weight; this can make a big difference to your plantar fasciitis and your general health.

Cross training – vary your exercise in different ways to train other parts of your body; this is a valuable method of reducing injury and keeping fit. Try swimming, cycling, aerobics, Pilates, yoga, weight training, rowing, circuit training.

Physiotherapy – this may involve different treatment options which may include manual techniques and specific exercises.

Other treatment options:

If initial treatments do not improve your symptoms, your physiotherapist or GP will discuss other options with you. These may include:

• Podiatry referral for shoe inserts
• Night splints to stop your plantar fascia from tightening up overnight
• Capsaicin cream
• Dry needling (a procedure to try to stimulate healing in the tendon)
• Extracorporeal shockwave therapy (a machine used to deliver sound waves to the painful area to stimulate healing)
• Surgery

The latest evidence suggests steroid injections are not the best treatment option. There is a risk of the plantar fascia rupturing (tearing) following a steroid injection, and it may cause wasting of the fat pad cushion under your heel. This can lead to long term problems.

Driving

It is important that you contact your insurance company to let them know about your injury. You may be able to drive once you are able to perform an emergency stop safely and fully operate your vehicle.

Exercises

• These exercises will be most effective if completed “little and often”
• They can be done every 2 hours
• Start exercising slowly and build up gradually
• Pain can increase initially but will soon settle down within a few days of starting the exercises
• Consider appropriate footwear – supportive shoes or lace up boots that go above the ankle are recommended

Home Exercises

Stretches

Stretch 1 - Plantar fascia – standing

• Place the front of your foot and toes against a wall and lean forwards from the ankle
• Hold for 1 minute

Stretch 2 - Plantar fascia – sitting

• Sit in a chair with your affected leg crossed over your good one
• Grab hold of your toes and bend them backwards until you can feel the stretch in the sole of your foot
• Hold for 1 minute

Stretch 3 - Soleus stretch

• Using a wall for support, plant your feet flat on the floor, one behind the other
• With your front knee bent, lean forwards, until you feel the stretch in the back of the calf muscle in your front leg
• Do not let your heel come up off the ground
• Hold the stretch for 30 seconds to 1 minute

Stretch 4 - Gastrocnemius stretch

• Using a wall for support, plant your feet flat on the floor, one behind the other
• With your leg straight, lean forwards until you feel the stretch in the back of the calf muscle in the leg behind you
• Hold stretch for 30 seconds to 1 minute

Rolling/Tissue Release

Plantar fascia soft tissue release with golf ball

• Place your bare foot on a golf ball
• Put some pressure through your foot and roll the golf ball backwards and forwards for 1 minute
• This helps reduce tightness in the plantar fascia
• Do these 2 to 4 times a day

Frozen bottle rolling

• Take off your footwear and place your foot on a frozen bottle of water
• Roll the bottle backwards and forwards under the arch of your foot
• Continue rolling for 5 minutes
• Do these 2 to 4 times a day

Physiotherapy

If you are unsure about what to do and feel you need support with your rehabilitation, then you can always go to see a Physiotherapist.

If you live in the Heywood, Middleton and Rochdale area, you can refer yourself by using the following link:
www.physiodirect.northerncarealliance.nhs.uk

Work

If you do not feel capable of working either due to pain or reduced movement/mobility, you are able to self-certify sickness for the first 7 days.

You must complete a self-certification form found on the government website and give this to your employer. This entitles you to statutory sick pay from your employer for up to 7 days.

To access the self-certification form, follow this link:
https://www.gov.uk/government/publications/statutory-sickpay- employees-statement-of-sickness-sc2

If you feel you need longer than 7 days off work, you must contact your GP for a sick note. The Urgent Treatment Centre does not issue sick notes.

If you require further information, please contact NHS 111 via telephone or their website, or you can contact Rochdale Urgent Treatment Centre – 01706 517023.