Our series on therapeutic exercises ends with orthopaedic surgeon Mr Rohit Madhav’s guide to plantar fasciitis and when exercise programmes are appropriate. A patient information leaflet and explanatory video are available online
Approximately one in 10 people will get plantar fasciitis at some point in their life, most commonly between the ages of 40 and 60, and especially in patients with arthritis and diabetes. It occurs twice as often in women. It can occur anywhere from the proximal heel insertion (80%) to its distal insertion at the base of the toes. In approximately 85% of cases the aetiology is unknown.
Known risk factors include ankle stiffness in dorsiflexion, obesity, and work or activities involving prolonged weight bearing/standing and can be precipitated by changes in footwear, daily routine, athletic training or terrain. The diagnosis is mainly based on history and clinical examination. Investigations mainly help with differential diagnoses. The classic symptoms are stiffness and pain following periods of rest, such as first thing in the morning or after prolonged sitting. This then eases off after a few minutes or steps, only to return with prolonged walking or standing as a progressive pain.
On the whole, plantar fasciitis has a very favourable prognosis and most people completely recover within one year.
Initial treatment involves a two to three week course of anti-inflammatory medication together with the use of 1cm heel lifts, reduction in prolonged weight-bearing activities, plantar fascial massage and exercises. Exercises are described below. Massage should be carried out with the plantar fascia at full stretch, for three to five minutes, morning and evening.
Three exercises are described in the box below and in the accompanying video and patient information leaflet.
Achilles tendon stretches involve the patient placing their hands against a wall, bringing the unaffected leg in front and bending it, creating a light stretch in the calf muscle. This is then progressed by also bending back the affected leg, creating a stretch lower in the calf muscle.
Plantar fascia stretches are done in a similar way, but involve bringing the toes forward so they are sliding down the bottom of the wall, while bringing the knee slightly forward to create a calf stretch.
Ice-bottle rolls involve rolling a frozen bottle of water under the sole of the affected foot, making sure the bottle rolls the entire length of the sole.
Stretches should be held for 30 seconds, repeated 15 times, two to three times a day. Ice bottle rolls should be done three to five minutes, twice a day.
In addition to the above, there is some evidence for using customised foot/ankle splints, steroid injections (guided by either palpation or ultrasound). Other emerging techniques include platelet-rich plasma injections and extra-corporeal shock wave therapy for more severe cases. Radiotherapy has also been used with some success. There is equivocal evidence for use of arch supports. Surgery may be considered in very difficult cases and is only advised if pain persists for more than 12 months.
Preventative measures include the use of appropriate footwear, weight loss, regular stretching activities and the avoidance of prolonged activities on hard surfaces.
Mr Rohit Madhav is a consultant surgeon at the London Orthopaedic Clinic
The London Orthopaedic Clinic holds free monthly education sessions for GPs. For more information: www.londonorthopaedic.com
This is the last in the series. Go to www.pulsetoday.co.uk/video/exercises to see the whole series, with accompanying patient information leaflets and videos.
• Knee osteoarthritis
• Anterior knee pain
• Lower back pain
• Subacromial impingement
• Tennis elbow
• Golfers elbow
• Plantar fasciitis
Patient leaflet on plantar fasciitis