Introduction
Time heals all wounds; but time also wounds all heels. The bottom of our feet do a lot of heavy work for us over our life. Many people will eventually develop quite severe pain on one or both heels. This is worse if they have tight calves and do a lot of walking.
One such condition is policeman’s heel; also known as plantar fasciitis. It is common, very painful and can generally be treated efficiency with an injection.
What is the Plantar Fascia and Plantar Fasciitis?
The plantar fascia (PF) is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing, and it helps with shock absorption when we walk and step.
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Irritation and scarring of the plantar fascia, known as Plantar Fasciitis is one of the most common causes of heel pain.
What causes plantar fasciitis?
Plantar Fasciitis results from chronic small trauma to the plantar fascia over many years. This causes a pulling force against the bone of the heel where the ligament is attached. Factors which make the trauma greater include obesity, unforgiving shoe wear and typically tight calves. The seated position is part of life in the modern world and it tends to cause a hunched over contracture of most people leading to tight calves; this transmits force to the plantar fasciia.
Interestingly, plantar fasciitis was originally called Policeman’s Heel, underlying the risk of constantly walking on hard pavement in dress shoes that the police had to face due to their jobs.
The traction of the ligament on the heel bone can lead to new bone growth; these are called heel spurs. This can be the area of pain due to nerve compression.
What are the symptoms of plantar fasciitis?
Plantar fasciitis is usually an excruciating, sharp heel pain which you feel first thing in the morning when you get out of bed. It is associated with tight calves. The pain occurs with each step and is sharp and limiting.
How can plantar fasciitis be diagnosed?
The doctor will examine the foot and push over the area of the plantar fascia where it connects to the hell bone. If this reproduces the pain, then the diagnosis of plantar fasciitis is very likely.
What is the treatment for plantar fasciitis?
The first step in treating plantar fasciitis is to offload the pressure on the plantar fascia. This involves rest as well as aggressive calf and lower back stretching. It is important to strengthen the abdomen, core and knee muscles (quadriceps) to offload forces distributed to the foot by these structures if weak.
Anti-inflammatories can be used to diminish the pain.
If this approach fails, and it often does, then the next step for relief is usually a steroid injection. Corticosteroids are medications which are used to reduce inflammation, such as in asthma or allergy. They can be injected with a small needle to the area of inflammation to dampen down the pain.
What is the injection like?
Your doctor will inject the plantar fascia with a small needle in the clinic. They will inject where it’s most painful. A corticosteroid injection will be given typically in conjunction with a local anaesthetic. Once the injection is done, the site is covered.
The patient is encouraged to restart exercise when it’s comfortable.
The numbing effect usually lasts a few hours after the injection. When this numbness wears off, your heel pain may return temporarily. The steroid will relieve heel pain over the next several days, and it will continue to work for several weeks to months.
Hard activities should be avoided for the first few days after the injection. How successful is the injection?
Steroid injections do not cure plantar fasciitis but they can relieve pain for 3-6 months. During this time, calf stretching can take place to relieve the underlying cause.
This is usually sufficient for most people.
What happens if it gets worse?
If the steroid injection does not work, it would usually be attempted again. If this is still not successful, a surgeon will assess whether excision of a part of the plantar fascia will help.
