Plantar fasciitis is a dread diagnosis for me. Not because it is “serious” but because it is a misery and there is so little I feel I can do to improve it. Physiotherapist Greg Turpin and GP Dr Mareeni Raymond have produced a step by step guide to this condition in GP Magazine 27 October 2014 where they describe what can be done. I am delighted to be able to summarise what their experiences are of treating patients with this condition.
Diabetics and those who are overweight are particularly likely to get plantar fasciitis. The condition is due to inflammation and degeneration of the connective tissue that connects the bones of the feet to the Achilles tendon at the heel. Glycation of tendon collagen is probably the issue with diabetics so the better your blood sugar control the better for your tendon health. The bones, muscles of the feet, the subcutaneous tissue and the skin are all linked by this fibrous band. Athletes and women are also particularly affected. High mechanical loads being carried by the feet and fashionable rather than “sensible” footwear are also factors in causation.
People complain of a feeling of a stone in their shoe or a burning pain around the heel. Pain can worsen as the day goes on and if walking barefoot. The sole of the foot or heel is usually tender and the pain can come on when the person points their toes towards their shin.
If the condition is of new onset stretching the foot and non- steroidal anti- inflammatory drugs such as Naproxen, Ibuprofen, Diclofenac or Meloxicam can be tried. The stretching is of itself uncomfortable to painful and must be done at least three times a day for 10 repetitions each foot. First thing in the morning and after periods of prolonged standing are recommended.
Heel pads can help. So can supportive shoes and cutting out weight bearing activities. Taping can be done by a physiotherapist and then can be continued by a patient who has been taught how to do this.
The authors reckon that 9 out of 10 people will be much improved after six months of such an approach. If a patient is keen to continue sports or has any musculo-skeletal abnormality earlier referral to a physiotherapist would be useful. If the condition is getting worse instead of better, the physiotherapist should also be consulted earlier to prevent the problem becoming chronic.
I often give patients non- steroidal gels to rub into the feet and I have also tried acupuncture. None have been that successful. Many diabetic patients also have high blood pressure and so cannot use non-steroidal anti-inflammatory drugs. Asthmatics and those with a history of stomach ulcers or poor renal function also cannot use these drugs.
It looks as though keeping slim, keeping blood sugars tightly controlled, wearing supportive footwear with low heels and probably regular stretching of the sole of the foot are the most useful things you can do to prevent this condition from occurring.
Have any readers helpful advice for those afflicted with this problem?