Plantar Fasciitis & Heel Pain

The plantar fascia is responsible for supporting muscles in the foot and absorbing shock from movements. However, with overexertion of this tissue can cause numerous microtears resulting in degeneration and inflammation.

Certain groups of people are at higher risks of plantar fasciitis. For example, it is more common amongst avid runners. Other factors that are associated with plantar fasciitis include:

• Age – plantar fasciitis is more common in people aged 40 to 60 years
• Obesity – Excess body weight can put additional stress on your foot
• Occupation – People whose jobs require long hours of standing on hard surfaces are more prone to plantar fasciitis. These include factory workers, sales personnel and teachers
• Footwear – Frequent wearing of high heels or shoes that don’t have adequate support can worsen the tear and inflammation at the plantar fascia
• Flat Feet or High Arched Feet – People with flat feet or high arches may experience additional strain to the plantar fascia from the way they stand and walk

You may need to have an orthopaedic doctor evaluate your foot if your symptoms have been present for 3-6 months, and is severely affecting your lifestyle.

In addition, a medical evaluation may be necessary if your symptoms do not fit the classifical presentation of the condition. Some examples of symptoms that may not be due to plantar fasciitis include:

• If you experience burning pain, numbness and tingling, especially at night
• If your pain worsens with prolonged weight-bearing instead of improving
• If you notice swelling, bruising or skin redness over the posterior heel
• If the onset of the pain was sudden acute and knife-like, especially after a minor injury

The doctor will ask you about your symptoms and examine your foot to assess the location of the pain, and rule out other possible causes of heel pain.

If you experience heel pain due to plantar fasciitis, your doctor may recommend either non-surgical or surgical heel pain treatments, depending on how severe your condition is. Non-surgical treatment is typically the first line of treatment considered.

Non-surgical Treatments

Most patients get better with the help of non-surgical treatments. These may include:

• Analgesics
  Pain relief medications can be taken to ease the discomfort while you recover.
• Physiotherapy
  This will involve teaching you effective stretching and strengthening exercises that correct underlying factors such as tightness of the calf muscles and weakness of the intrinsic foot muscles. These exercises help to increase the flexibility of the calf muscles, stretch the plantar fascia and strengthen the intrinsic muscles of the foot.
• Changing your footwear
  Refrain from wearing footwear that is too tight and does not give enough support for your feet, such as flip-flops. Your may also consider getting shoe inserts or orthotics to support the arch of the foot and distribute pressure optimally.
• Non-Steroidal Anti-inflammatory Drugs (NSAID)
  Non-steroidal anti-inflammatory drugs (NSAIDs) are helpful in reducing pain and swelling caused by plantar fasciitis. However, NSAIDs can only alleviate pain temporarily. It is best to consult an orthopaedic doctor who can advise you on the most appropriate treatment for your case.

Usually, heel pain from plantar fasciitis will subside and recover within 6-18 months. However if your symptoms are not improving or are affecting your lifestyle severely, we can offer heel pain treatment options in Singapore (for pain resulting from plantar fasciitis) including injections and minimally-invasive surgery like the Tenex procedure.

• Injections
  Our doctors can offer steroid injections or ultrasound-guided platelet-rich plasma (PRP) injections. PRP is obtained by drawing a small amount of the patient’s blood and centrifuging it to concentrate the platelets. These activated platelets are then injected into the injured or diseased body tissue. This releases growth factors that stimulate the healing of the inflamed portions of the plantar fascia.
• Extracorporeal Shock Wave Therapy
  With this non-invasive procedure, shock waves are directed towards the plantar fascia to promote tissue healing. Some slight discomfort might be felt but the treatment takes only about 5 minutes.
• Tenex Procedure
  Commonly used in the treatment of tennis or golf elbows, this minimally-invasive surgery makes use of ultrasound imaging to guide a needle-like probe into the inflamed tissue, before releasing high-frequency ultrasound vibrations to break up/debride the diseased tissue causing pain. Tenex is a safe and relatively painless procedure, and is performed as an outpatient surgery.
• Endoscopic Plantar Fasciotomy (EPF)
  Endoscopic plantar fasciotomy (EPF) is a minimally invasive procedure for chronic plantar fasciitis. During the procedure, your surgeon will make one or two small incisions and use a small camera to get a better view of the fascia. Thereafter, a part of the fascia near the heel bone will be cut in order to release the tension that is causing the pain.

Contact Axis Orthopaedic Centre for a consultation to see if we can help to alleviate your symptoms from plantar fasciitis!