During the stance phase of step and run movements, the plantar fascia is stretched significantly, causing a great deal of stress around the insertion on the medial tubercle of the calcaneus. Over time, calcification can occur along the length of this band that produces a typical radiological heel spur. The presence of these kinds of spurs is not necessarily linked with the presence of pain – heel spurs are often found by chance during X-rays for other injuries that have not caused the patient any pain, whilst some patients experience very painful plantar fasciitis in the absence of a heel spur.
This condition is common amongst athletes involved in running, dancing, tennis and basketball, especially if they have increased their load too quickly during training.
It may also present itself in older individuals who have started wearing flat shoes, those who are overweight, people required to wear unsuitable shoes for work reasons and those with irregularities in their arches (flat feet, hard soles and those with a tendency to hyper-pronate). Generally speaking, this condition tends to be chronic as it is often overlooked or neglected by sufferers for several months whilst it worsens.
Symptoms usually consist of severe pain during the first steps of the day which gradually improve after some movement, before flaring up again later on. Swelling may also be present around the affected area. It is not uncommon for patients to experience deficits in strength and extensibility of the calf muscles.
X-rays, ultrasound and possibly electromyography scans are useful in establishing a diagnosis. Electromyography is especially useful if there is any numbness or paralysis due to associated nerve compression.
In the short term, the patient must stop all sporting activity (with the exception of swimming and cycling) and attempt to reduce the effect of predisposing factors (avoid wearing inappropriate footwear, or losing weight for example). Using insoles may help correct any abnormalities in the plantar arch. Shockwave therapy can be very effective at reducing inflammation in these conditions.