The plantar fascia is a thick strip of tissue on the sole of the foot that runs from the heel bone (calcaneum) to the toes. This tissue supports the arch of your foot and is incredibly important for your foot to work normally. In certain circumstances this tissue can become inflamed and sore at the point where it joins onto your heel bone. This occurs due to microscopic tears in your plantar fascia from mechanical overload. These microscopic tears then try and heal through an inflammatory process, but the healing scar tissue is weaker and inflamed. This is then more prone to repeated microscopic tears that will in turn heal with weaker tissue. This is known as a “cycle of tear and disrepair” and once it starts it is difficult to settle it down. Some patients have symptoms for a short time which then get better on their own, but once plantar fasciitis gets into a chronic cycle it is much harder to treat.

Plantar fasciitis can be incredibly painful and have a significant impact on your life. Your heel pain may be worse in the mornings, feeling incredibly tender to put your heel down first thing. This often settles somewhat throughout the morning but returns each time you sit down for a period of rest.

As a foot and ankle specialist I will take a detailed history to understand your symptoms and how they are affecting you. An examination of your foot will elicit whether your heel pain is likely to be caused by plantar fasciitis or whether it is more likely to be due to one of the other causes of heel pain (there are several others). An MRI scan can confirm the diagnosis, assess the severity and rule out other causes of heel pain, some of which are more serious.

Plantar fasciitis can usually be cured without any surgery, especially if the correct, specialist treatment is implemented as early as possible. If you do have symptoms of plantar fasciitis, seeing a specialist as early as possible means this can likely be cured without any surgical intervention. Several changes have to be implemented at the same time to address the mechanical overload and the biological changes all at once to enable the tissue to heal. Treatment will be tailored to you, and this may include lifestyle changes, insoles, exercises, physiotherapy or certain medications. If it doesn’t settle, then procedures are available to correct the mechanics of your foot and improve the biology of the healing tissue and I find these are significantly more effective when implemented together rather than one at a time.

It is my opinion that you shouldn’t let anyone inject steroids into your plantar fascia. Although this could briefly reduce your symptoms, it does not address the cause and the steroids further weaken the plantar fascia. It is highly likely your problem will come back and be more resistant to future treatments and your plantar fascia can even rupture after a steroid injection, which can dramatically and permanently alter the way your foot works.