I was a regular runner until 18 months ago, when I started to feel a "stretching" sensation in the sole of my left foot and woke one morning with a terrible pain in my heel. I have subsequently had this diagnosed as plantar fasciitis. Despite wearing inserts in my shoes and having a steroid injection in my heel, it still hurts when I walk and I can't run at all. What should I do?

The plantar fascia is a strong band of tissue that goes from the heel to the toes and helps maintain the arch of the foot. With ageing and overuse, the fascia of the heel-bone can degenerate and plantar fasciopathy (PF - commonly, but incorrectly, called plantar fasciitis) develops. PF is more frequent in women and patients who are overweight, have very flat feet, very high arches or do a lot of walking, running or standing on hard surfaces. A common misconception is that PF is an inflammatory lesion: in reality, there is little evidence of inflammation. The normal advice given is to rest for six to 12 weeks and do home exercises to stretch your plantar fascia, while avoiding running. There has been a recent trend for special bed socks that keep your foot bent towards your shin at night, which may be effective. Often, nonsteroidal anti-inflammatory medications are used, and the heel is injected with corticosteroids. However, as the condition is not an inflammatory one, their effect is dubious and short-lived. Extracorporeal shockwave therapy - a form of physiotherapy whereby low-frequency shockwaves are directed towards the area of pain - has been tried and seems to be effective in long-standing cases. When all else fails, surgery can be attempted, but it is not a quick fix: it can take nine months to see any benefit and only 70% of patients return to full pain-free status. There are other conditions around the heel that may mimic PF: an orthopaedic surgeon specialising in foot and ankle problems will know if it is another ailment.

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