Plantar Fasciitis

Plantar fasciitis usually gets better without surgery. Calf and plantar fascia stretches, cushioned supportive shoes, insoles and ice help most people, and the NHS advises seeing a GP if the pain has not improved after 2 weeks of self-care. Surgery, a small calf-muscle release behind the knee, is considered only after several months of failed treatment.

Plantar fasciitis is one of the most common causes of heel pain. It occurs when the plantar fascia, the thick band of tissue supporting the arch, becomes irritated or inflamed. Heel pain is common; the NHS notes plantar fasciitis is more likely between the ages of 40 and 60.

Symptoms

• Sharp or stabbing pain at the base of the heel
• Pain that is worst with the first steps in the morning or after rest
• Discomfort that eases with activity but worsens with prolonged walking or standing
• Tenderness in the heel or arch

Common contributing factors include repetitive strain from walking, running or prolonged standing; tight calf muscles or Achilles tendon; poorly cushioned or unsupportive footwear; being overweight or recent weight gain; and flat feet or high arches.

How it is diagnosed

Plantar fasciitis is usually diagnosed from the history and an examination, with tenderness where the fascia attaches to the heel and a tight calf. A heel spur on an X-ray is not, on its own, the explanation for the pain — spur removal is rarely advised.

Non-surgical treatment

Most people improve with simple measures, given time:

• Well-cushioned, supportive footwear, and avoiding flat, unsupportive shoes
• Stretching exercises for the calf and plantar fascia
• Ice therapy (the NHS suggests up to 20 minutes every 2 to 3 hours)
• Anti-inflammatory medication, such as ibuprofen
• Orthotics or insoles to offload heel pressure
• Night splints to gently stretch the fascia during sleep

Ultrasound-guided steroid injections for persistent cases. Injections are not risk-free: Mr Hester co-authored a published case report (Fox et al., BMJ Case Reports 2013) describing calcification of the plantar fascia, with later ulceration and infection, after a corticosteroid injection. The benefits and risks are discussed before any injection.

Extracorporeal shockwave therapy (ESWT) is another option for chronic heel pain. NICE guidance (originally IPG311, now HTG200) found no major safety concerns, but describes the evidence on its effectiveness as inconsistent, so it should only be used with special arrangements for clinical governance, consent and audit or research.

When surgery helps

It is uncommon to need an operation for heel pain. Surgery is considered only after several months of failed conservative treatment. The most common procedure is a proximal medial gastrocnemius recession, a small release of the calf muscle behind the knee to reduce tension on the plantar fascia. It is performed as a day case through a small incision.

Recovery timeline after gastrocnemius recession

• 0–2 weeks: rest with the foot elevated, in a protective dressing or boot.
• 2 weeks: wound review, sutures trimmed and a move into light footwear.
• 2–4 weeks: walking in supportive trainers, with gentle stretching.
• 4–6 weeks: walking and daily activity gradually increased.
• 6–12 weeks: return to most normal activity.
• 12 weeks and beyond: running and impact activities may resume if pain-free.

How Mr Hester can help

Mr Hester is a dual fellowship-trained foot and ankle surgeon (FRCS Tr&Orth), a member of BOFAS and EFAS, and a Consultant at King's College Hospital. He sees patients with heel pain at The London Clinic, Cromwell Hospital, King Edward VII's Hospital and HCA The Shard.

Insured patients need a GP referral and an authorisation code from their insurer; self-pay patients are welcome. To book, call 020 7046 8004.

Frequently Asked Questions

Sources

1. Plantar fasciitis. NHS. https://www.nhs.uk/conditions/plantar-fasciitis/
2. Extracorporeal shockwave therapy for refractory plantar fasciitis (HTG200, formerly IPG311). NICE, 2009. https://www.nice.org.uk/guidance/htg200
3. Fox TP, Oliver G, Wek C, Hester T. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis. BMJ Case Rep. 2013;2013:bcr2013200303. PMID: 23955985. https://pubmed.ncbi.nlm.nih.gov/23955985/