What is plantar fasciitis?

The plantar fascia is a thick band of fibrous tissue that runs from the heel bone to the base of the toes.

Inflammation at the site where the fibrous plantar fascia joins the heel bone is known as plantar fasciitis. Some experts believe small degenerative tears occur, and the tear is followed by inflammation.

The plantar fascia is gristly, like the white sinew on a leg of lamb. This means it does not have much in the way of blood supply nurturing the tissue, which means a problem with the fascia can take some time to heal.

Plantar fasciitis is a common problem - up to 10% of people experience it at some point in their lives.

Pain from the condition is typically a sharp knife like pain at the base of the heel. The pain usually occurs on weight-bearing after the person has been resting. Getting out of bed in the morning and that initial step is typically the most intense pain. The pain eases with movement, but then usually worsens as the day progresses, particularly with long periods of standing or walking.

X-rays may show a spur or outgrowth of the heel bone. This is more common in people who have plantar fasciitis but is not the cause of the problem. The spur tends to occur as a result of the inflammation.

What causes plantar fasciitis?

Plantar fasciitis is more common in people aged over 40. It is also more likely to occur in women.

The condition often occurs without any obvious reason. It is more likely to occur when somebody starts to exercise, such as starting to walk regularly or starting to run. Putting on weight puts more stress on the foot and increases the likelihood that problem will develop.

How might work contribute to the development of plantar fasciitis?

Standing and weight bearing for long periods, particularly on hard surfaces, increases the likelihood of the condition. People who stand all day in their job are significantly more likely to develop plantar fasciitis.

Some studies indicate that people standing on hard floors are up to 8 times as likely to develop the plantar fasciitis. If somebody stands consistently on the job there's a reasonable chance work has contributed to or caused the problem.

What are the most effective ways of dealing with plantar fasciitis?

Plantar fasciitis is a difficult problem to treat, which typically runs its course and gets better over many months with or without treatment.

Various treatments are tried. sometimes they help and often they don't.

Anti-inflammatory tablets help some people. They don’t cure the problem but help the pain.

Orthotics or shoe inserts are the most common form of treatment. Orthotics may be off-the-shelf shoe inserts, bought at a pharmacy. Custom-made orthotics (typically through a podiatrist) are also recommended. Custom-made orthotics are significantly more expensive ($400 versus $40 from the chemist) and we don't have evidence that they are more effective. Nevertheless, plantar fasciitis is a very frustrating problem for the sufferer and most people will be keen to try all recommended strategies.

The aim of orthotics is to alter the pressure dynamics within the foot, taking pressure off the area where the plantar fasciitis joins the heel bone. That may be done by altering the arch of the foot, or simply a shoe insert with a cut out area to take pressure off the heel.

Stretching the affected area is another alternative; some studies show this is moderately effective. Another way of stretching the heel is to put a splint on the foot at night. Stretch exercises and night splints aim to pull the toes upwards towards the head, or dorsiflexing the foot to stretch the plantar fascia where it joins the heel.

Cortisone injections into the heel are incredibly painful and do not have high success rates. Surgery can be done for long term cases but has a low likelihood of success.

Shockwave therapy has been trialled but has not been shown to be of benefit.

Generally plantar fasciitis will improve with time, but usually takes months. Providing employees with appropriate work duties is probably the most sensible way to help them recover.

What work duties are appropriate for plantar fasciitis?

There is no clear evidence that restricting a person's duties and activities will fix their condition. Nevertheless, it's a painful problem and giving someone restricted duties allows them to remain productive and at work. It may well help the problem heal.

Avoiding prolonged weight-bearing is the most sensible way of restricting duties. That doesn't mean a person should be sitting all day, but avoiding standing for long periods is recommended.

The flexibility to sit for a while and then stand to move around is a major advantage. Giving a person bench work activities with a high chair allows them to alternate sitting and standing. That flexibility allows them to be more comfortable. If they sit continuously over the day there is no movement to stretch the affected area, so sitting continuously is not necessarily good. The ideal job has them sitting but still doing some walking. Walking or standing continuously should be avoided.

Involve the person when you are looking for a work-duty solution; they will often tell you how long they can stand before they are sore. At first they might be comfortable being on their feet 15 minutes at a stretch, but as their problem improves they should get better at standing for longer periods. Involve them in discussions and you'll be in a better position to help them stay active and productive.

As the problem usually takes months to heal, think about transitional work that will be available for months rather than weeks. Because the problem takes so long to heal it can be frustrating for the worker and the workplace. Sensible planning reduces the angst for all.

A graduated increase in duties and return to a person's normal job can generally occur over a 3 to 9 month period.