PLANTAR fasciitis (PF) is the second most common condition that I see in my podiatry clinic, with diabetic foot problems being the first.

PF is a condition that involves pain in the plantar fascia and associated bones. The plantar fascia is a thick band of fibrous tissue that connects the heel to the toes.

It will commonly cause pain in the heel, but sometimes the pain will branch out to other areas of the foot. The pain is usually worse first thing in the morning, after rest, or after sitting for prolonged periods of time. It can also be triggered by long periods of standing.

Sudden damage, damage over many months or years can cause tiny tears in the PF. This then leads to thickening of the tissues and inflammation. In about 70 per cent of cases, it is unilateral, that is in one foot, but some patients are unlucky enough to have it in both.

If the plantar fascia continues to be overused without treatment, it can rupture. In this case, a clicking or snapping sound may be heard. There would be local swelling with acute pain. Surgery would be necessary in this case.

Risk factors

There are several risk factors that predispose one to developing this condition. Occupation can play a big part. If your job involves long periods of standing, like teaching, gardening, hotel work etc, you may be more vulnerable.

Obesity is another factor. Excess weight puts pressure on the plantar fascia and foot in general. Certain types of exercise can aggravate PF. Activities that place a lot of pressure on the heel and surrounding tissues can contribute to the early onset of PF, for example long distance running.

Tight Achilles tendons, being flat-footed and having a high arch can adversely affect the way weight is distributed when you are standing and put added stress on the PF. Flat, non-supportive footwear is also a major contributor. In Jamaica we wear a lot of flip-flops and slippers which I feel is one of the main reasons why PF is so common here. People between the ages of 40 and 60 are most likely to get PF, but it can present at a much younger age.

It is important to seek help if you develop the symptoms of PF. Ignoring it can lead to chronic heel pain that will hinder your day-to-day activities. Patients with long-standing untreated PF often develop foot, knee, hip, or back problems.

Treatment

Rest. Avoid walking long distances and standing for long periods.

Wear well-fitted, supportive shoes that are laced or strapped. Try to purchase shoes that have cushioned soles. Running sneakers are the best type of footwear for this condition. Avoid flip-flops and being bare-footed for at least one month. Arch supports may be helpful and can be purchased from most pharmacies. On occasion, I manufacture specific devices to go within the shoe (orthotics) to help alleviate the pain.

Stretching exercises for the calf and plantar fascia are essential. I will usually devise a programme of particular stretches that loosen the Achilles tendon, plantar fascia and calf muscles.

Pain relief should come in the form of ice packs and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen.

If you are overweight, lose it! The vast majority of patients I see with PF are obese.

Most cases will resolve or show signs of resolving within six weeks on this treatment programme. If adhered to properly, there should be no need for steroid injections, extra corporeal shock wave therapy, surgery, or other expensive treatments.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293-7119), Mandeville (962-2100), Ocho Rios (974-6339), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.