Plantar fasciitis is a major cause of heel pain, and can cause considerable disability. I’ve seen people come in to my clinic using a walking stick because of it. Some people have to stop doing sport completely, and some people even find it difficult to stand for long periods because of the pain.
Luckily, in most people it’s a temporary condition, and the pain goes away by itself or after doing simple things such as changing to better footwear or using orthotics, resting the feet, and seeing a physiotherapist.
However, there is a small group of people in whom the pain continues despite those simple measures, and it is those people who I am going to write about today.
The first thing to do as a patient is to get a firm diagnosis. Plantar fasciitis causes heel pain, but not all heel pain is caused by plantar fasciitis. There are several ways to get the condition diagnosed, but the best way is to see a specialist with an interest in this disease. If there is doubt about the diagnosis then the doctor may ask for investigations, which may include an ultrasound scan or an MRI scan.
It’s important to stress again that that you really should try simple things like painkillers, resting, changing footwear, orthotics, and stretching exercises first, as 80% of people will find that the foot feels better with these measures. But if you still have pain after 6 – 12 months then there are various options available:
This is the use of X-rays to treat disease. It is commonly used in high doses to treat cancer, but increasingly doctors are using it for non-cancer conditions. X-rays are aimed towards the painful area, and it has been shown to be 80% effective by six weeks after the treatment.
Importantly, the effect seems to be durable (i.e. the pain generally doesn’t return). A very low dose of radiation is used, which doesn’t cause any side-effects. Overall this seems to be a very effective treatment. The only thing to discuss with your doctor is that radiation does have a very small risk of causing cancer in the area. It is probably about 0.01% to 0.1% lifetime risk, which is pretty miniscule, but your own risk should be discussed carefully with the doctor.
This is the use of shockwave treatment on the sole of the foot. It is an attractive option in some ways as it can be administered by a physiotherapist or sports doctor, but it is important to realise that it can be quite painful. Also, the evidence in support of this treatment is somewhat inconclusive and contradictory.
These can be effective, but can be painful, and generally only give temporary relief.
This can be very effective in some cases, but can have various complications. I would advise trying everything else before you consider surgery.
In my opinion, radiotherapy should be used more for the treatment of plantar fasciitis. I suspect that it is under-used mainly because many people do not know how effective it is, but there may be other factors, such as having established referral habits and long-held beliefs that influence this.