Symptoms & Treatment: Plantar fasciitis

What is plantar fasciitis?

The plantar fascia is a strong band of tissue that stretches along the underside of the foot, under the skin, from your heel to the middle of the foot.²

This ligament normally acts as a shock absorber and supports the arch of your foot, but when it becomes overloaded or overused, the plantar fascia can start to degenerate. This results in pain in the heel, known as plantar fasciitis.³

Symptoms for plantar fasciitis

For many people who are later diagnosed with plantar fasciitis, the main symptom is pain under the heel, which is often described as sharp.

Pain occurs with the first few steps taken in the morning and tends to improve throughout the day.²

Causes and risk factors for plantar fasciitis

Plantar fasciitis is a repetitive strain condition affecting approximately 10% of the population at some point in their lives.⁴

For most people, the pain improves with general measures such as rest, stretching, and changing footwear. However, in about 20% of people who suffer from the condition, the heel pain can persist.^2,4

Factors which may increase your risk of developing plantar fasciitis include:⁴

Standing for very long periods
Increased weight
Excessive running
Sedentary lifestyle

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Diagnosing plantar fasciitis

An initial assessment and discussion are important to help understand the uncertainties and alternative treatment options.

At the assessment, your specialist will discuss whether radiotherapy might be helpful for your condition, as well as side effects you may experience.

Note: You will need a referral from a GP or specialist for an assessment.

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Treatment options for plantar fasciitis

Management and treatment of plantar fasciitis depends on the severity of your condition.⁵

Your GP and specialist will discuss the best options with you.

Treatment options include:^1,2,4

Physiotherapy – stretching, counter-strain techniques
Over-the-counter anti-inflammatories
Steroid injections
Extracorporeal shock wave therapy
Ultrasound
Surgery
Radiation therapy

Radiation therapy

Radiation therapy may be used to help relieve the pain associated with plantar fasciitis.^4,6,7 In general, radiation therapy is best suited for people who are still experiencing pain and discomfort after failure of other treatment measures for more than 6 months.^5,7,8

During your treatment, radiation is aimed towards the area of pain in your heel.¹Radiation therapy has an anti-inflammatory effect and promotes healing in the fascia.⁸

A clinical trial has shown radiotherapy to be more effective than steroid injections, with approximately 85% of patients noting an improvement in discomfort 6 months after treatment.¹

A technique called external beam radiation therapy is used to treat plantar fasciitis, and it is delivered by a linear accelerator (LINAC).^6,9

Treatment is usually delivered over 6 outpatient visits, with the option to repeat another 6 treatments after 12 weeks.

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Content reviewed by

Review Date: October 2024

Prof Jarad Martin

MBChB BSc PhD DMed, FRANZCR GAustMS

Radiation Oncologist

References

Canyilmaz, E., Yoney, A., Aktuğ, S., & Çetin, E. (2015). Low-dose radiotherapy in the management of plantar fasciitis: Long-term results. International Journal of Radiation Oncology, Biology, Physics, 92(3), 659–666. https://doi.org/10.1016/j.ijrobp.2015.02.009
Thompson, J. V., Saini, S. S., Reb, C. W., & Daniel, J. N. (2014). Diagnosis and management of plantar fasciitis. The Journal of the American Osteopathic Association, 114(12), 900–906. https://doi.org/10.7556/jaoa.2014.177
Buchanan, B. K., & Kushner, D. (2023). Plantar fasciitis. In StatPearls. StatPearls Publishing. Retrieved July 2023, from https://www.ncbi.nlm.nih.gov/books/NBK431073/
Trojian, T., & Tucker, A. (2019). Plantar fasciitis. American Family Physician, 99(12), 744–750. https://www.aafp.org/pubs/afp/issues/2019/0615/p744.html
Schwartz, E. N., & Su, J. (2014). Plantar fasciitis: A concise review. The Permanente Journal, 18(1), e105–e107. https://doi.org/10.7812/TPP/13-113
Ott, O. J., Jeremias, C., Gaipl, U. S., Frey, B., & Schmidt, M. (2015). Radiotherapy for benign calcaneodynia: Long-term results of the Erlangen dose optimization trial. Strahlentherapie und Onkologie, 191(1), 1–6. https://doi.org/10.1007/s00066-014-0618-0
Royal College of Radiologists. (2023, March). Recommendations for using radiotherapy for benign disease in the UK. Retrieved July 2023, from https://www.rcr.ac.uk/publication/recommendations-using-radiotherapy-benign-disease-uk
Rogers, S., Eberle, B., Vogt, D. R., Meier, E., Moser, L., Gomez Ordoñez, S., Desborough, S., Riesterer, O., Takacs, I., Hasler, P., & Bodis, S. (2020). Prospective evaluation of changes in pain levels, quality of life and functionality after low dose radiotherapy for epicondylitis, plantar fasciitis, and finger osteoarthritis. Frontiers in Medicine, 7, Article 195. https://doi.org/10.3389/fmed.2020.00195
Hermann, R. M., Bruns, F., & Nitsche, M. (2017). Low dose radiotherapy of painful heel spur/plantar fasciitis as an example of treatment effects in benign disease. In C. Onal (Ed.), Radiotherapy (pp. 143–172). InTechOpen. https://www.intechopen.com/chapters/53798

Plantar fasciitis