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Plantar fasciitis

 

Imaging - Please include an up to date X ray with weight bearing views report within or attached to the referral.  This includes for soft tissue injuries to exclude underlying pathology.  .

Referrals without up to date reports included and Xrays that are not weight bearing will be returned, unless there are mitigating circumstances why this is not possible



Referrals for USS guided steroid injections to RCHT Clinical Imaging have restarted.  Please note there is limited capacity so referrals should be reserved for patients with significant disabling and persistent symptoms.  Please click here for full details

 

Covid-19 Update: Corticosteroid Injections During The Coronavirus Pandemic  

Please ensure and document that a discussion has happened that the patient is aware corticosteroid injections pose a possible and quantifiably unknown increased risk of, and complications from, Covid and the possible risk of reduced Covid vaccine efficacy prior to performing.  Secondary care referrals for steroid injection, including image guided injections, require the patient to be counselled and risk assessed prior to referral and this documented in the referral.  Please see guidance available here for detailed information. 





Primary Conservative Management:

  • Relative rest – break up periods of aggravating activity such was walking, standing, running with non weight bearing rest such as sitting
  • Avoid walking barefoot until symptoms settle and wear supportive footwear, even indoors
  • Weight loss
  • Exercise, both strengthening and stretching exercise information here Heel Pain (Plantar Fasciopathy) | IPRS Health Portal (mskr.info)
  • Over-the-counter arch support/heel cushions
  • Simple analgesia and an icepack for symptomatic relief.
  • 6 months Physio (exercises need to be done by patient 3-4 times/day)

 

If no improvement after 6-12 weeks consider:

  • Referral to podiatry for made-to-measure orthotics
  • Steroid injection – performed blind – trial of 1 injection
    Rare risk of fat pad atrophy, skin atrophy, plantar tendon rupture

USS guided steroid injection can be given by a radiologist if blind injection unsuccessful– request on ultrasound request form direct to RCHT radiology department.

Reassess at 4-6 months (most patients will have symptomatic improvement 2-3 months after starting 2nd line treatment)

 

Non-surgical treatments available in secondary care:

  • In resistant cases consider night splinting - maintains dorsiflexion – available from Occupational therapy bracing service at RCHT
  • Extracorporeal Shock Wave Treatment is not routinely commissioned on the NHS.
    • Private referral can be made (£55 per treatment, 3-4 treatments recommended) at the Duchy

 

Refer for Surgery:

  • After 6 months if conservative measures have failed.

Surgery is rarely required. Removal of heel spurs is never done.

 


REFERENCES:

NICE Clinical Knowledge Summaries: Plantar Fasciitis, May 2020

 

Contributors

Tariq Karim, Trauma Practitioner, Royal Cornwall Hospitals NHS Trust

Morissa Livett, MSK Clinical Lead Physiotherapist, Cornwall Partnership Foundation NHS Trust

Dr Rebecca Hopkins, GP Orthopaedic Guidelines Lead, Kernow CCG

 

Date reviewed                     08/02/2022

Next review due                  08/02/2023

Sifter name                          Dr Rebecca Hopkins

 

 

 

Version No. 1.2