heel pain

Common Conditions – Plantar Fasciitis

WHAT IS PLANTAR FASCIITIS?  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. 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 use the name plantar fasciopathy or chronic heel pain (CPHP) to reflect this change in thinking.

WHAT ARE THE SYMPTOMS OF PLANTAR FASCIITIS? 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 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.

WHAT CAUSES PLANTAR FASCIITIS? If you are in a weight bearing occupation, are overweight or have tight calf muscles, you are more likely to develop heel pain. As it is an overuse syndrome, increasing your training intensity or volume too quickly is also a risk factor.

WHAT TO DO AT HOME: Stop running and stretch your calf muscles and plantar fascia. Activities that do not aggravate the heel pain are usually fine to replace your running activities (cross training/cycling/swimming). Avoid barefoot walking and wear supportive and well-cushioned shoes. Generally I would recommend a cushioned type shoe, such as a running shoe with a heel height differential of around 10-12mm. 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.   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. If you are overweight, losing weight is recommended.

WHEN TO SEEK HELP FOR PLANTAR FASCIITIS: If your symptoms have not improved after a short period of stretching, book and appointment with a Podiatrist. It is vitally important to get an accurate diagnosis of your condition before undertaking any further treatment as there are many differential diagnoses for CPHP that are treated in a different manner.

HOW IS PLANTAR FASCIITIS TREATED? Some studies have shown that patients with heel pain also have weak foot muscles so it makes sense to strengthen these. The Short foot exercise is often advised, as are eccentric loading exercises. Strapping is something I use a lot with my patients who are suffering with heel pain. It is a very good method of firstly reducing their pain levels and also leading my treatment plan.  Orthoses are generally very helpful in treating heel pain. If conservative measures fail, injection of steroid may be considered.