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Fasciitis and tendinopathy

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Plantar fasciitis

Plantar fasciitis is very common.


It causes pain beneath the heel of the foot which is characteristically worse first thing in the morning or when putting the foot to the floor after a period of rest.


It is caused by excessive tension in the thick fibrous band of tissue which runs under the foot. It is commonly associated with a tight calf muscle. People who are overweight or diabetic are more prone to develop plantar fasciitis although it can occur in anyone.

The condition is self-limiting, meaning that eventually it will burn itself out. There are a number of treatments which may be helpful in reducing the severity and duration of treatment:

  • Physiotherapy is the mainstay of treatment. Stretching exercises aim to release tension in the calf muscle and the plantar fascia.

  • Shockwave therapy is a non-invasive treatment in which mechanical energy is delivered to the tissue in order to promote healing. When used alongside a structured physiotherapy regime around three-quarters of patients will have significant pain relief. We have a shockwave machine at KIMS Hospital and for patients wishing to fund their own treatment there is a competitively priced physio/shockwave package available.

  • Steroid injections may temporarily reduce plantar fascia pain. They are very painful if done whilst you are awake so I routinely preform the injection under sedation in the operating theatre. Although an injection is likely to reduce symptoms, it is not permanent and would be administered alongside a physiotherapy programme. There is some risk of tissue damage associated with steroid injections, particularly if someone has had multiple injections in the past.

  • If the calf muscle remains particularly tight despite a supervised stretching regime, it can be released through a small incision behind the knee. This can usually be done under local anaesthetic and may be helpful in cases which have failed to settle with shockwave and physiotherapy.


Achilles tendinopathy

Pain at the back of the heel may be caused by Achilles tendinopathy


Achilles tendinopathy includes many different and distinct problems – overgrowth of bone, micro-tears of the tendon, inflammation of the lining of the tendon or irritation of the fluid-filled sac behind the tendon.

Collectively these issues are referred to as Achilles tendinopathy. In order to identify the cause of pain and swelling a careful history and examination is required. Often an MRI scan is useful.

Treatment depends on the exact cause of pain.


In many cases lifestyle modification, insoles and physiotherapy are all that is needed. Physiotherapy can be augmented with shockwave therapy, a non-invasive treatment to stimulate tissue healing. 


Sometimes an operation to remove a bony prominence from the heel or repair damaged tendon may be needed. Recovery from Achilles surgery is often quite slow, requiring two weeks in plaster and several further weeks thereafter in a boot.

If you are suffering from heel pain please make an appointment and we can arrange the necessary investigations to start you on the road to recovery.

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