Plantar fasciitis, a real pain in the……. heel
Plantar fasciitis is one of the most common conditions that we treat in the clinic, and it can be an extremely frustrating condition. It will affect around 10% of the population and makes up around 15% of all adult foot complaints. The plantar fascia is a broad band of dense connective tissue similar to tendon and ligament that originates from the heel bone (calcaneus) and inserts into each of the toes, forming a fan shaped structure. It serves an important role in foot and lower limb mechanics.
Patients suffering from plantar fasciitis will typically complain of pain affecting the underside of the heel, especially when getting out of bed in the morning or on standing after sitting for a period of time. The pain may improve after a few minutes of walking but will return after prolonged periods of weight bearing activities.
In the athletic population plantar fasciitis is common in long distance runners, footballers, dancers and basketball players. It has been quoted that 10% of those who are active in running sports will develop plantar fasciitis. In the non-athletic population plantar fasciitis is more likely to affect you if you are overweight, in a weight bearing occupation, over 50 years old or have limited range of movement at the ankle joint.
Despite what you have been told it is now thought that plantar fasciitis is NOT an inflammatory condition. It is now thought that the process is more likely a degenerative one and the literature supports this. As a result Podiatrists and other health care providers have started to describe the condition as plantar fasciopathy or chronic plantar heel pain (CPHP) to reflect this change in thinking.
How is CPHP treated? Well there are lots of options out there…. Here is generally what I’d recommend as first line treatment:
1) STRETCHING of the calf muscles is a good place to start when you develop heel pain. Stretching the sole of your foot has also been shown to help with the pain associated with this condition.
2) ICE Although there is little (if any) inflammation involved with this condition, ice works well as an analgesic and will help control the pain, especially if you’ve had a long day on your feet.
3) STRAPPING is something I use a lot with my patients who are suffering with heel pain as it is a very good method of reducing their pain in the short term. Using a rigid tape like zinc oxide, it not only supports the foot and plantar fascia but also helps compress the plantar heel fat pad.
4) ORTHOSES are special medical devices that are used to treat many conditions including CPHP. There are many different types of orthoses and it is important you take advice as to which are best for you.
5) FOOTWEAR is a really important part of treating heel pain. Generally I would recommend a cushioned shoe such as a running trainer with a heel height of around 10mm. This type of shoe offers arch support, shock absorption/cushioning, is light and comfortable to wear and also allows me to accommodate an orthotic if necessary.
6) AVOID BAREFOOT WALKING at all costs, it is likely that this will aggravate your symptoms.
7) REST the foot as much as possible. Avoid high impact sports that include running or jumping.
8) WEIGHT-LOSS If you are overweight you are more likely to develop heel pain. Losing weight is recommended as a preventative measure and also as part of treating the condition.
As always it is vitally important to get an accurate diagnosis of your condition before undertaking any treatment plan. There are many differential diagnoses for CPHP that are treated in a different manner. If you are suffering from heel pain or know someone who is please get in touch.