Plantar Fasciitis

What is Plantar Fasciitis?

The plantar fascia is a thick band of connective tissue running along the underside of the foot, from the heel bone to the base of the toes. It supports the arch and absorbs load with every step. When it is subjected to repetitive stress, small tears develop at the point where it attaches to the heel, causing pain and local degeneration.

Plantar fasciitis is the most common cause of heel pain in adults. It tends to affect people who stand or walk for long hours, those with tight Achilles tendons or a high or flat arch, and anyone who has recently increased their activity level significantly. It is also more common in the 40-70 age range. Imaging is not always necessary, but ultrasound confirms the diagnosis by showing a thickened fascia at the calcaneal attachment.

The defining symptom is pain on the first few steps in the morning or after any period of rest. Paradoxically, the pain often eases with movement and returns after prolonged activity.

Symptoms

• Sharp or stabbing heel pain on the first steps after waking or after sitting
• Pain that improves after a few minutes of walking but returns with prolonged activity
• Tenderness on the underside of the heel, close to the arch
• Tight, aching sensation along the bottom of the foot
• Worsening of pain after standing for long periods
• Occasional swelling around the heel

How We Treat It

Shockwave therapy is our first-line interventional treatment for plantar fasciitis and has one of the strongest evidence bases of any procedure we use. It delivers focused acoustic energy to the fascial insertion, stimulating tissue repair and reducing pain over a course of sessions. Most people see significant improvement within 4 to 6 weeks. It avoids the structural risks that can come from repeated steroid injection into a load-bearing tissue.

When pain is severe enough to prevent engagement with rehabilitation, an ultrasound-guided steroid injection at the fascial insertion provides rapid relief to create a window for physiotherapy and stretching. For cases with clear degenerative change on ultrasound rather than pure inflammation, PRP injection at the fascial attachment promotes tissue regeneration. Stretching of the plantar fascia and calf, along with appropriate footwear advice, is essential alongside any procedure to prevent recurrence.