The Health Flyer
Heel pain - Plantar fasciitis
In this month ’ s edition , Neil Liffen , director of East Coast Physio Ltd ( ECP ) discusses plantar fasciitis ( PF ), which is one of the most common conditions affecting the foot . Plantar fasciitis may be confused with ‘ policeman ’ s heel ’ but they are different . Policeman ’ s heel is called plantar calcaneal bursitis - inflammation of the sack of fluid ( bursa ) under the heel bone ( calcaneus ) and this is not as common as PF .
Anatomy
The plantar fascia is a strong fibrous band on the sole of the foot , which helps support the arch . It arises from
ECP specialise in diagnostic ultrasound ( if clinically indicated ) in combination with physical examination to ensure accuracy in your diagnosis and enhance specific targeted treatment .
LOCATED IN GP SURGERIES AT :
Felixstowe Grove Medical Centre 01394 288444 Ipswich Two Rivers Medical Centre 01473 356215 Leiston The Leiston Surgery 01728 642955
Further details : www . eastcoastphysio . co . uk
the heel bone and inserts into the toes ( Figure 1 ). The heel bone is protected by a specialized pad of fat that cushions it when we stand and helps protects the attachment of the plantar fascia .
Figure 1 . Plantar fascia
Treatment options
� Manipulative " hands on " therapy � Acupuncture � Extracorporeal Shock Wave Therapy � Soft tissue or joint injections � Plus other treatments - see website for details
Symptoms and risk factors
Commonly , symptoms include sharp or stabbing sensation in the region of the heel , typically when weight bearing from sleeping or from getting up from a chair after a period of rest ( start-up pain ). Start-up pain often resolves but may be replaced by a dull constant aching or throbbing pain on prolonged weight bearing or walking , and at the end of the day or during the night . There is no definitive underlying reason for PF , but risk factors include weakness and tightness of your calf muscles , prolonged standing or weight bearing , being overweight or sudden weight gain .
What causes PF ?
There are several theories as to the cause of PF , but the most likely is that mechanical overload and excessive strain results in micro-tears in the tissue of the heel that in turn give rise to thickening of the fascia . Repeated overload may hinder or prevent normal healing and may result in chronic inflammation and degeneration of the tissues and causes pain when the heel is compressed .
Diagnosis
In the majority of cases your clinician will be able make the diagnosis from the symptoms and examination findings alone . Occasionally , it is necessary to perform investigations , such as X-rays , Ultrasound and MRI , to confirm the diagnosis or exclude other causes of heel pain . Bony spurs were once recognised as contributing to PF , but are a common finding in persons without PF , and research supports this . One of the advantages of appointments with Neil Liffen , is the use of Ultrasound on the day of your appointment , if clinically indicated . Ultrasound may be utilized to assess for plantar calcaneal bursitis , plantar fascia tears / ruptures or rule in or out other pathology .
Treatment
There are a number of conservative treatment options , which may be effective in the treatment of PF . At ECP , we also offer extracorporeal shockwave therapy for PF , which has a significant growing evidence base for its effectiveness . In recalcitrant PF cases , Neil Liffen can offer ultrasound guided injections . If conservative management fails , surgical options may be option . Fortunately , PF is a selflimiting condition and in most patients ( 80-90 %) the symptoms will get better within 10-12 months .
Neil Liffen , currently combines his working week as an Extended Scope Physiotherapist and as a Musculoskeletal Diagnostic Sonographer . He combines working at East Coast Physio , with performing diagnostic ultrasound for several radiology departments based in NHS hospitals . Therefore , he has vast experience in performing ultrasound on plantar fascia and treatment , including injections .
24 THE FLYER | SEPTEMBER 2018
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