Can Plantar Fasciitis Be The Cause Of Your Heel and Foot Pain?

Dr. James - Orthopaedic Surgeon in Singapore

Medically reviewed by Dr. James Tan

Plantar fasciitis is one of the most common conditions of pain in the heel and bottom of the foot. This condition is most common among runners, athletes, overweight individuals, and people who wear shoes that do not provide adequate support. It can be quite a painful condition that can even make putting your foot on the ground impossible. This article discusses everything you need to know about plantar fasciitis, its causes and symptoms, and its treatment options in Singapore.

What is Plantar Fasciitis?

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To understand what plantar fasciitis is, we must first understand the anatomy of the foot. Apart from the bones, tendons, and ligaments in the foot, there is a thick band of tissue that runs across the bottom of the foot and connects the heel bone to your toes. This band of tissue is a ligament called the plantar fascia which also supports the arch of your foot. If this ligament gets irritated or inflamed, it can cause pain in the bottom of the foot.

The tension in the plantar fascia intensifies during weight-bearing and pushing off during walking or running.

Testing for Plantar Fasciitis

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First Step Test

If you feel pain in the heel that gradually fades as you walk in the morning, there is a chance you may get plantar fasciitis.

The ‘Hot Spot’ Test

  • Find a chair and bend your knee
  • Place your affected foot on the opposite knee
  • Use your thumb to press firmly on the heel area

If you experience notable pain or identify ‘hot spots’, it could be a sign of plantar fasciitis.

Causes and Risk Factors of Plantar Fasciitis

The main function of the plantar fascia is to absorb the stress and strain that the foot experiences while doing activities like walking, running, jogging, or playing sports. But sometimes, too much on this ligament can cause it to tear and become damaged. As a response to this injury, the area becomes inflamed, resulting in stiffness of the plantar fascia and bottom of foot and heel pain.

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Plantar fasciitis can occur due to an incorrect movement or stress on the foot while doing any activity or for no particular reason at all. However, there are a few risk factors that can make you more prone to get this condition:

  • Repetitive high-impact activities such as running on hard surfaces and jumping can strain the plantar fascia, leading to inflammation.
  • Tight calf muscles and Achilles tendon can increase stress on the plantar fascia, especially when you don’t stretch regularly.
  • Inadequate warm-up or cool-down increases the risk of injuries including plantar fasciitis.

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  • Jobs that require prolonged standing or walking on hard surfaces
  • Medical conditions such as rheumatoid arthritis and diabetes
  • People belonging to the age group 40 and 60

Signs and Symptoms

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Signs and symptoms of plantar fasciitis are:

  • Persistent pain in the arch or near the heel that can last for months
  • Difficulty walking when the pain is severe
  • Swelling, although uncommon. It is recommended to consult a specialist as soon as possible.
  • Stiffness in the foot
  • Pain in the foot especially when you wake up in the morning or after prolonged periods of rest. The pain seems to subside after walking for some time.
  • Increased pain after vigorous activity.
  • More intense pain when barefoot or while wearing shoes that provide minimal support.

If you’re experiencing these symptoms, here’s how you can manage the pain at home.

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  1. Proper footwear: Opt for shoes with a supportive arch, good cushioning and a proper fit. Avoid walking barefoot on hard surfaces.
  2. Get gel inserts: They add cushioning and support, alleviating pressure on plantar fascia.
  3. Elevate your feet: Reduce swelling by elevating your feet when you rest.

You can also check out these effective stretching exercises to relieve tension in the plantar fascia and calf muscles.

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Toe stretches

  • Gently pull your toes back using your hands
  • Hold for 30 seconds

Calf stretches

  • Stand facing a wall, place one foot forward and lean into the wall. You will feel the stretch in your calf
  • Hold for 30 seconds

Towel stretches

  • Extend your legs and loop a towel around the ball of your foot
  • Gently pull the towel towards you
  • Hold for 30 seconds

Do note that these home remedies may vary for different people. If your symptoms persist or worsen, consult a specialist.

How is Plantar Fasciitis Diagnosed?

The first step in diagnosing plantar fasciitis is a physical exam that your orthopaedic doctor will conduct. The doctor will also ask you about the symptoms and move/press your foot at various angles to look for any inflammation or assess if the pain pattern changes with movement or pressure. The doctor will also inquire about your daily routine and activity level to see when you feel pain the most.

Usually, an orthopaedic specialist will not need to carry out any other test or imaging procedures like MRI, x-ray, or CT-scan. However, the doctor may order these imaging tests if he suspects that the pain or inflammation may be caused by any other condition or to rule them out.

Plantar Fasciitis Treatment in Singapore

Plantar fasciitis treatment in Singapore usually comprises conventional treatment options that do not require surgery. However, in some cases, some kind of surgical intervention may be necessary to get to the root of the problem and fix it. Let’s go through these various non-surgical and surgical treatment modalities.

Non-Surgical Treatment Options

Most cases of plantar fasciitis can effectively be treated with non-surgical methods including the following:

Rest

One of the most important steps to ensure recovery from this condition is to rest and avoid activities that may aggravate the condition further. This can mean avoiding jumping, running, dancing, or walking too much.

Activity Modification

It is necessary for a person suffering from plantar fasciitis to modify his/her activities so that the pressure and strain on the foot can be reduced. In addition to other foot pain treatment modalities, your doctor will advise you to modify your activities and avoid the ones that cause more pain or inflammation.

Stretches

One of the most effective ways to manage and treat the pain associated with plantar fasciitis is to do calf and plantar fascia stretches. This is because this condition is caused by tight muscles in the calf and plantar fascia, so when they are stretched, it helps a lot in relieving the pain. Your doctor or physical therapist will demonstrate to you how to do calf and plantar fascia stretches that should be done regularly, each day to ensure quick recovery. Ideally, both these structures should be done in the morning before you stand up or start walking.

Ice

Applying ice on the underside of the foot for 15-20 minutes several times a day can also help with the pain and inflammation. An effective way to ice your foot is to roll it over a cold water bottle for several minutes.

Medication

Your orthopaedic doctor may also prescribe you pain-killer medication including non-steroidal anti-inflammatory drugs such as ibuprofen, acetaminophen, or naproxen. Usually, the pain associated with plantar fasciitis can be managed through over-the-counter pain medication. However, the doctor may prescribe stronger painkillers if he feels the need. The stronger painkillers should only be taken according to the doctor’s advice for the duration that the doctor has prescribed.

Cortisone Injections

In some cases, the doctor may administer a steroid injection into the plantar fascia to help reduce swelling and pain. However, this is not a very common treatment method as the steroid injection can lead to the weakening of the plantar fascia which could consequently result in its tearing or other painful conditions.

PRP Injections

Another emerging technique that has shown promising results in managing plantar fasciitis pain and inflammation is plasma-rich platelet injections. PRP is taken from the patient’s body and injected directly into the plantar fascia to promote healing and recovery.

Supportive Footwear

If you are suffering from plantar fasciitis, it is crucial that you start wearing supporting footwear. A large part of the pain caused in the heel is because of the tension that the fascia experiences when the heel strikes a hard surface. Wearing shoes with thick soles and supporting heel cushioning ensures that the tension on the fascia is reduced and consequently, any damage to it and pain is also reduced. You can easily buy pre-made silicone shoe inserts (orthotics) or heel pads and place them in your shoes to provide cushioning to the heel.

Moreover, it is important not to wear very high heel shoes. Shoes that have worn out must not be worn as they do not provide enough elevation and cushioning to the heel.

Physical Therapy

Physical therapy is another important component of conservative treatment methods. A qualified physical therapist can help you manage your pain through a custom-made treatment plan that includes exercises, stretches, massages, and other related therapies. The therapies mainly focus on the calf muscles and plantar fascia to reduce tension and promote healing.

Casting

Another technique that helps the foot heal faster is to wear a foot cast that restricts its movement. You can achieve a similar result by wearing boots, however, a cast is more appropriate as it is custom moulded according to your foot and cannot be removed. This helps create a conducive environment for the fascia to heal.

Night Splints

The reason why most patients feel pain after waking up in the morning is because of the way their feet are positioned during sleep. Most people sleep with their feet pointing downwards which relaxes the plantar fascia. After hours of relaxation, the fascia causes heel pain when you wake up. A night splint is a type of brace that stretches the plantar fascia by keeping your toes pointing upward as you sleep. Although it can be a bit difficult to get used to, it can greatly reduce your heel pain in the morning.

Ultrasonic Tissue Repair

This is a minimally invasive procedure that is often recommended for patients who have recurrent plantar fasciitis problems. In this procedure, ultrasound is used to send waves to the plantar fascia which causes it to vibrate. The aim is to break up the damaged tissues in the fascia and remove them.

Extracorporeal shockwave therapy (ESWT)

Another non-invasive procedure that is used to promote the healing of the injured fascia is extracorporeal shockwave therapy (ESWT). During this therapy, high-energy shock waves are administered to the fascia that may help stimulate the healing process. Although ESWT has not shown consistent success rates among patients, it is still given a chance since it is a non-invasive, low-risk procedure. ESWT is often tried for patients who qualify for surgical treatment to see if there is any chance of healing without surgical intervention. In case of no improvement, the surgical route is taken.

Percutaneous needle tenotomy

Percutaneous needle tenotomy is a minimally invasive procedure in which a thin, small needle is used to poke holes in the fascia. Ultrasound imaging is used to guide the thin needle towards the fascia where it pierces the damaged fascia tissue on several points. The needle piercing (tenotomy) stimulates an acute inflammatory response and an increased blood flow to the region. This increased blood circulation then promotes healing of the injured plantar fascia.

Surgical Treatment Options

Plantar fasciitis is a condition that responds quite well to conservative, non-surgical treatment methods. Even for stubborn plantar fasciitis cases, the doctors usually stick to different aggressive non-surgical treatment methods for many months in the hope that patients might recover. If, however, there is no improvement even after many months of non-surgical treatment options, the doctor may recommend surgery. Plantar fasciitis surgical treatment in Singapore comprises the following options:

Gastrocnemius recession

One of the main reasons for pain in the plantar fascia is the tightness of the calf (gastrocnemius) muscles. The tight gastrocnemius can put increased stress on the fascia, causing it to damage further. If patients have been doing calf stretches but do not seem to be going anywhere with them, the doctor may order this procedure in which one of the calf muscles is lengthened.

The calf is primarily made up of two muscles. In gastrocnemius recession, one of these two muscles is lengthened to decrease the stress on the fascia and to provide the ankle with enough room to increase its movement. It also allows the heel to move downward in a more relaxed position. This procedure can be done through the traditional intramuscular surgery where an incision is made into the calf and the muscle is lengthened manually or it can be done through an endoscope where small incisions are made and a thin tube (endoscope) with a camera at its end is used to guide the surgery done with thin, specialised surgical tools. Depending on the severity of the condition that is being treated, your doctor will decide whether to go for intramuscular surgery or endoscopic surgery.

During the procedure, the orthopaedic surgeon detaches a small portion of the gastrocnemius muscle from where it is connected to the Achilles tendon. The surgeon then either removes a small part of the muscle or creates incisions in order to lengthen the muscle. Depending on the patient’s condition and needs, the surgeon makes the desired lengthening in the muscle which reduces tension in the muscle-tendon connection. Once the desired lengthening of the muscle is achieved, the surgeon attaches the gastrocnemius muscle back to the Achilles tendon through sutures or other techniques. Finally, the incisions are closed through staples or sutures and a dressing is applied to the surgery site. The surgeon may also carry out other procedures that plantar fascia release simultaneously with this procedure.

If you are experiencing pain in the heel, it could be a sign of Achilles tendon injury, and it is best to seek surgical treatment as soon as possible to avoid more severe injuries.

Plantar fascia release

Plantar fascia release is a surgical procedure in which the surgeon removes or releases a damaged part of the plantar fascia ligament. The plantar fascia tissues that are inflamed and causing tightness on the heel are released or removed in order to reduce tension on this ligament. A surgeon may recommend this surgical procedure if conservative measures of treating the issues have failed and the patient has been suffering from chronic pain for at least 6 to 12 months.

The procedure for a plantar fascia release is somewhat similar to the gastrocnemius recession procedure, but instead of releasing the calf muscle, the plantar fascia ligament is released in this procedure.

During surgery, the surgeon creates an incision in the sole of the foot to access the plantar fascia. In some cases, the surgeon will make small incisions into the plantar fascia to release the tension on the tissue thereby reducing inflammation in the ligament and surrounding areas. In some more complex cases, the surgeon may have to detach the plantar fascia from the heel, remove any damaged tissues near the plantar fascia, and/or remove any bone spurs related to the condition. The plantar fascia may be attached back to the heel at the end. In the end, the outside incisions are closed up through sutures or staples and a sterile dressing is placed on the site. The foot is then placed in a cast to promote healing and quick recovery.

This kind of surgery may be done through standard surgery where the surgeon operates directly on the plantar fascia or it may be done endoscopically where an endoscope and thin surgical instruments are used to operate through small incisions on the foot.

How to Prevent Plantar Fasciitis

The outlook for plantar fasciitis is excellent with the majority of patients experiencing improvement in symptoms and complete healing within 2-3 months of conservative treatment. However, a very small percentage of patients may not feel any improvement even after months of treatment. In such cases, the doctor may suggest surgery for plantar fasciitis. Almost 75% of patients also experienced significantly less pain and stiffness after the surgery. However, whether you have been treated with conservative treatment options or surgery for plantar fasciitis, it is crucial that you maintain a healthy lifestyle and best practices to prevent the condition from arising again and to provide the foot with a conducive, healing environment. These best practices include the following:

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  • Supporting your feet with good shoes that provide adequate arch support to reduce stress on the plantar fascia. Avoid shoes with worn-out soles or inadequate support.
  • Doing daily stretching exercises of the calf, ankle, and plantar fascia to reduce tension in this muscle-ligament connection and ensure greater ankle mobility and inversion. Icing your plantar fascia for 10-15 minutes after exercise, running, or other vigorous activities can also go a long way in releasing tension in the ligament and preventing pain and inflammation in the heel.
  • Explore low-impact exercises such as swimming and cycling as alternatives to high-impact activities like running.

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  • Pay attention to how you walk and run. Ensure your stride is natural and watch for excessive inward or outward rolling of your feet.
  • Consider orthotic inserts for additional support and proper foot alignment if you have flat feet or high arches.
  • Maintain a healthy weight as excess weight can stress your feet, especially the plantar fascia.

By following these simple lifestyle practices, you can not only prevent plantar fasciitis from reoccurring but they are also very effective to avoid having this condition ever in your life. Plantar fasciitis, although quite a debilitating condition, has a good prognosis and can be treated through non-surgical and surgical treatment methods. If you are suffering from heel pain and want to get treated in Singapore for plantar fasciitis, then Ray of Health can provide you with all the right information and guidelines. For more information about plantar fasciitis treatment in Singapore and other orthopaedic conditions, get an appointment with Ray of Health today.

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About The Author

dr james tan

Dr James Tan Chung Hui

Dr James Tan is a skilled orthopaedic surgeon at Quantum Orthopaedics who has more than 10 years of experience in sports surgery and exercise medicine in Singapore. Apart from partnering with the industry to introduce various treatment techniques, Dr Tan has treated athletes from the Singapore National Teams and professional footballers from the Singapore Premier League and the Young Lions.

Dr Tan specialises in treating sports injuries of the knee, shoulder and elbow joints, as well as cartilage and meniscus surgery. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.

Qualifications and Achievements
MBBS - National University of Singapore (NUS), Faculty of Medicine
Member of the Royal College of Surgeons of Edinburgh (MRCS)
MMed - Master of Medicine in Orthopaedic Surgery (NUS)
Fellow of Royal College of Surgeons (Edinburgh)
Adjunct Assistant Professor | NUS, LKC
Senior Consultant Orthopaedic Surgery, Sports and Exercise Medicine
Head of Department | Orthopaedic Surgery and Sports Medicine Centre
Awards
Principal Investigator of Tissue Engineering
National Medical Research Council grants
Collaboration with Scientists at NTU, TUM, A*Star, Osteopore & Trendlines Medical Singapore

Accreditations

  1. Mount Elizabeth Orchard
  2. Mount Elizabeth Novena
  3. Farrer Park Hospital
  4. Mount Alvernia Hospital
  5. Aptus Surgery Centre
  6. Novaptus Surgery Centre

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