The aftermath of Covid has seen increased rates of plantar fasciitis, says foot and ankle physiotherapist, Andrew Wynd.

“We have seen a great increase in heel pain presenting in the clinic, and we suspect this is for a few reasons,” explained Mr Wynd.

“The first being that working from home has meant more time sitting and less activity, often walking around barefoot at home on hard surfaces.

“The other fascinating finding from recent research is there is a clear association with plantar fasciitis and mental health. Higher rates of anxiety and depression seem to coincide with increased likelihood of plantar fasciitis, so I suspect Covid has also contributed in that mechanism too.”

The plantar fascia is a band of connective tissue under the arches of our feet – connecting the heel bone to the toes. When this band gets inflamed and painful, this is called plantar fasciitis.

Recently, the medical fraternity is moving towards a different name – plantar heel pain, as recent studies suggest the fascia itself is not always the source of the pain. Either way, it’s a painful experience, said Mr Wynd.

“Typically the underside of the heel becomes sore, especially first thing in the morning or after sitting down for prolonged periods and then getting up to walk again. It can be exquisitely painful, like stepping on  a burning hot spear right into the heel.”

Understanding the cause is the tricky part, he said, as this can vary, making treatments less effective if they are not specifically targeted.

“Commonly accepted causes include poor footwear, excessive pronation (rolling in arches), walking on hard surfaces and sometimes a trapped nerve,” he said.

“Sudden changes in activity - increase or decrease - can also contribute, and we also know hormonal fluctuations can cause this too. Finally weight gain is also associated with plantar fasciitis.”

While most people have heard of a heel spur, and traditionally it was thought this was the cause of plantar fasciitis, recent surgeries to remove the spur have seen symptoms remain, leading the physiotherapy profession to believe that soft tissues - including the fascia - were the more likely culprit.

“Whilst it often gets worse, the curious aspect of this condition is that it eventually does go away. This can sometimes take months or years, but most cases resolve over time.”

Although a variety of treatments exist, it’s important that the tissue causing the pain is properly identified; that way, a more targeted approach can be taken.

“Exercises including stretching the calf, and strengthening the muscles of the feet are often effective,” Mr Wynd said.

“Combining exercises with supportive shoes and often an arch support is a proven combination that helps most people. Other treatments include massage, night splints - more invasive options, such as shockwave therapy and cortisone injections are still being used for stubborn cases, but are usually not the first line treatment.

“Finally, surgery has shown to be effective for difficult cases that have failed the treatments outlined. Clinically, we use a staged approach, and found that exercise combined with manual therapy/manipulation and massage is very effective.”

Getting to the root cause is the secret to effective treatment. “The pain can be debilitating and as such the earlier intervention can be provided the better. A detailed, thorough assessment identifies any biomechanical issues, nerve entrapment, footwear issues and then treatment is directed at addressing those contributing factors.”