Plantar Fasciitis Treatment London | Private Ultrasound Diagnosis & Injections

Plantar Fasciitis Explained

Basic Plantar Heel & Ankle Anatomy

The plantar fascia is a tendinous tissue that runs across the bottom of the foot, extending from the heel to the toes.

It can be stretched and made taut if the big toe is extended. The plantar fascia plays a critical role during walking: as we toe off (and as the big toe extends), the plantar fascia is tightened across the underside of the foot. This action pulls the arch tight, creating a rigid lever to push off with.

When the big toe is not extended, such as when the heel first strikes the ground, the plantar fascia remains more relaxed.

Symptoms of Plantar Fasciitis

Plantar heel pain (plantar fasciitis) describes a painful condition affecting the underside of the heel.

Often, the condition is caused by irregularities and inflammation of the insertion point of the plantar fascia onto the underside of the heel bone (calcaneum) — hence the term plantar fasciitis.

Due to the location of pain, plantar fasciitis can cause significant disability during weight-bearing, particularly:

• During the first steps of the day

• With prolonged walking

• With running or other impact activities

Causes of Plantar Fasciitis

Current evidence suggests that plantar fasciitis may develop due to a combination of:

• Direct ground reaction forces acting on the insertion of the plantar fascia

• Tensile stress through the fascia (similar to other tendinopathies)

• During prolonged periods of lying or sitting, the plantar fascia is held in a shortened position.

As a result, symptoms are often more pronounced on initial weight-bearing — especially during the first few steps after periods of inactivity — due to the sudden stretch and load through the plantar fascia.

Diagnosing Plantar Fasciitis

A diagnostic ultrasound scan is the gold standard imaging technique for analysing the quality of the plantar fascia tissue.

Ultrasound can detect:

• Areas of tendinopathy

• Tears in the plantar fascia

• Insertional bony irregularities at the bone-tendon interface with the calcaneum

Additionally, ultrasound can identify abnormalities in the plantar fat pad (the fatty tissue beneath the skin on the sole of the foot), which is critical to differentiate from true plantar fascial disorders — prior to planning safe and effective treatment.

Ultrasound Guided Injections for Plantar Fasciitis

How is an Injection Administered for Plantar Fasciitis?

An ultrasound-guided injection, when performed using the following technique, is a well-tolerated procedure and, contrary to common belief among both clinicians and patients, usually causes only minor discomfort.

In this technique, the needle is not injected through the sensitive sole of the foot.

Instead, with the calcaneum, plantar fascia, and fat pad visualised in transverse plane (by placing the ultrasound probe across the sole of the foot), the needle is introduced from the medial (inside) aspect of the foot, visualised in-plane parallel to the ultrasound image.

• Typically, an initial injectate of local anaesthetic is delivered to the fascial plane between the superficial plantar fascia and the plantar fat pad.

• Once the correct plane is confirmed, corticosteroid is injected into this space.

• This technique ensures no direct interference with the plantar fat pad itself.

What to Do After Your Plantar Fasciitis Ultrasound Guided Injection

Needle Path & Post-Injection Pain
Contrary to what is thought a plantar fascia ultrasound guided injection is very well tolerated as the needle path does not enter the sole of the foot but can be guided from the medial inner aspect of the heel where the skin and tissues are far less sensitive. 

Some local and aesthetic will be used during the procedure so there is no immediate discomfort under ordinary circumstances. 

Due to the steroids reacting with the surrounding tissues there may be a post injection steroid flare in a small number of cases lasting 2-3 days where there is some increased discomfort.

Wound Care & Infection Risk
Avoid exposing the injection site to dirty or public water (e.g., swimming pools, hot tubs) for 2–3 days to reduce infection risk. Monitor for redness, swelling, or discharge at the injection site and contact me immediately if these occur.

Activity Guidance
Following an ultrasound guided injection for plantar heel pain it is strongly advised to reduce all significant activity for up to two weeks post injection and gradually increase activity following this timeframe as symptoms dictate.

Follow-Up
If you experience unusual pain, swelling, redness, or any other concerns following your injection, please contact me immediately.

Other Treatments for Plantar Fasciitis

Pain Relief for Plantar Fasciitis

Stretches for Knee Plantar Fasciitis

Strengthening Exercises for Knee Plantar Fasciitis

Plantar Fasciitis | Evidence base

Plantar fasciitis is a common cause of heel pain, characterised by degeneration and thickening of the plantar fascia at its calcaneal origin, often with associated morning pain and activity-related symptoms. The condition is frequently self-limiting but may persist for many months without targeted management. Evidence strongly supports conservative treatment as first-line care, including load modification, calf and plantar fascia stretching, strengthening, footwear optimisation, and orthotic support. Injection therapy is reserved for persistent, function-limiting pain that has failed to respond to an adequate trial of conservative care. Ultrasound-guided corticosteroid injection has moderate evidence for short-term pain relief, particularly in the early months following injection. Ultrasound guidance improves injection accuracy, allows confirmation of fascial thickening and exclusion of alternative pathology, and reduces the risk of intrafascial injection, fat pad atrophy, and plantar fascia rupture. Repeat injections should be limited due to diminishing benefit and increased risk of tissue injury. Overall, ultrasound-guided injection is a useful adjunct for short-term symptom control in plantar fasciitis, facilitating engagement with rehabilitation, while long-term outcomes remain dependent on progressive loading and biomechanical management.

Questions about your heel pain?