Plantar fasciitis also known as policeman heel is a thick fibrous band of tissue at the bottom of your foot that lies between your toes and your heel. Repeated small injuries to the plantar fascia are believed to be the cause of the inflammation.
What are the cause for this is condition?
- If you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it. Also, people with a sedentary lifestyle are more prone to plantar fasciitis.
- If you have recently started exercising on a different surface – for example, running on the road instead of a track.
- If you have been wearing shoes with poor cushioning or poor arch support.
- If you are overweight – this will put extra strain on your heel.
- If there is overuse or sudden stretching of your sole. For example: athletes who increase running intensity or distance; poor technique starting ‘off the blocks’, etc.
- If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia.
What is the treatment for Plantar fasciitis?
The first line of treatment for heel pain should always be Conservative therapy. You should be seen by a medical practitioner such as a physiotherapist, osteopath, chiropractor or podiatrist. Who can give advice and manual therapy on the foot and calf areas. Footwear modifications can also be very helpful – simple heel cushions relieve pressure from the painful part of your heel. We recommend that you try first line treatment at least three months before moving on to further treatment such as Shockwave therapy, steroid injections or other surgical interventions.
Shockwave therapy for heel pain
Your first consultation with us is free this will ascertain your suitability of the treatment and answer any questions you have. If shockwave therapy is indicated we will arrange the sessions at weekly intervals, 3-4 sessions is normally recommended.
Each session takes approximately 30 minutes. This will also include acupuncture, passive stretching advice on night splits and footwear.
Patients often experience some discomfort during the procedure and there may be a little redness on the skin after treatment this is a normal reaction . occasionally the foot pain becomes slightly worse after treatment before getting better.
We use the latest Stortz shockwave therapy machine,
How does shockwave therapy for heel pain work?
It is understood that shockwave therapy works in two ways:
- Shockwaves cause micro damage to tissue in the affected area and in so doing, stimulate healing. Nature gets a second chance.
- The treatment has a direct effect on the nerve endings which make them less sensitive and therefore less likely to transmit pain.
The benefit of shockwave therapy for heel pain is often not felt until after the third session. The treatment works well for 80 per cent of patients. The effect of the treatment is usually permanent and there is no need to return for further sessions at a later date.
NICE (National Institute for Health and Clinical Excellence) recently evaluated shockwave therapy for heel pain in August 2009. The recommendation was that the treatment is effective and should be offered, providing centres audit their results and inform patients of possible side-effects. You can read the guidelines on the NICE website: www.nice.org.uk
What evidence is there that shockwave therapy for heel pain works?
Non-steroidal anti-inflammatory drugs: (for example, ibuprofen). Ask your GP or pharmacist for advice before taking any medication.
Appropriate footwear : wear shoes with extra cushioning, for example, running trainers. Do not walk bare foot or on hard surfaces.
Orthotic devices : are insoles that fit into your shoe to support your foot and help your heel recover. You can buy orthotic devices from sports shops and large pharmacies. Alternatively, you can ask for advice from your podiatrist. If your pain doesn’t respond to treatment and keeps recurring, or if you have an abnormal foot shape or structure, specially made orthoses to fit the shape of your feet are also available.
However, currently there is no sufficient evidence to suggest that custom-made orthoses are better or more effective than those bought off-the-shelf.
Exercises: Your Chiropractor will give you give you exercises to allow stretching of both your calf muscles and your plantar fascia the band of tissue that runs under the sole of your foot). This should help to reduce the heel pain and improve flexibility in the affected foot.
Night splint: most people sleep with their toes pointing down this means that the tissue inside the heel is being squeezed together. Night splints, which look like boots, are designed to keep your toes and feet pointing up while you’re asleep. This stretches both the Achilles tendon and your plantar fascia, which should help with your recovery.
Steroid injection: If treatment hasn’t helped relieve your painful symptoms, your GP may recommend steroid injections. More than 98% of patients’ symptoms will be resolved with this treatment. However, it may take up to 18 months for your symptoms to clear. Occasionally, symptoms re-occur and treatment is again necessary.
Surgery is rarely required and would only be recommended if all other treatments had failed. There are associated risks and possible complications including infection and persistent pain and damage to the small nerves in the heel, causing tingling and numbness. Division of the plantar fascia can result in a flat foot.