Plantar Fasciitis
Plantar heel pain is commonly referred to as “plantar fasciitis”. This condition is defined as pain or discomfort in the bottom of the heel. As podiatrists, we see this issue as the number one soft tissue or overuse injury.
It is generally characterised in its early stages by pain or
discomfort when rising from rest, especially if a lot of time has been spent on
the heel during the day. In the case of
morning pain, it will generally occur if a big day was had the day before.
Plantar Fasciitis impact
In its infancy, this discomfort seems to settle after a couple of minutes of walking around, however, if the problem is left to worsen it can get to a stage where any type of weight-bearing activity is painful. I have seen cases where patients have had to resort to the use of crutches and moon boots just to perform basic daily tasks.
Plantar Fasciitis Causes
Plantar Heel Pain can be caused by many different risk factors. The main factors we see are a sudden change in activities (i.e. increased walking, running, jumping, employment that requires more standing), and changes in footwear.
Some people are predisposed because of biomechanics (e.g. poor foot function or poor proximal hip stability) or systemic factors (e.g. age, menopause, elevated cholesterol, increased susceptibility to pain, weight etc).
Predisposed people may develop Plantar Heel Pain with even subtle changes in their activity.
Plantar Fasciitis Treatment
When treating the condition my primary aims are to address two main issues. The first is to reduce compressive load (squashing up against the bottom of the calcaneus or heel bone) and the second is to reduce shear forces around the heel generally increased by foot function or footwear.
We feel it is
important to address Plantar Heel Pain as soon as possible and to be aggressive
with treatment. Generally speaking, the
longer a patient has had this problem the longer it will take to resolve it.
Plantar Fasciitis Treatment Plan
Our general treatment plan for Plantar Heel Pain is as follows:
- Taping in the first instance. In particular to support the fat pad under the heel so it can act as a “cushion” and reduce the compressive load on the heel.
- Footwear change. This does depend on the foot type we are treating, however, the main aims are to reduce the compressive and shear forces on the heel.
- Strengthening Program for the small muscles of the foot
- Calf Muscle Stretching and Strengthening
- Manual Therapy to increase the ankle’s range of motion. This can be done by both you and your clinician (if appropriately skilled)
- Dry Needling of the intrinsic muscles to treat painful trigger points. Similar to acupuncture dry needling is the use of acupuncture needles to stimulate trigger points in the myofascial (the stuff that surrounds the muscle) which in turn reduce tightness and alleviates pain
- Orthoses. We now have evidence that custom foot orthoses provide for much better outcome at 12 weeks than exercises and footwear changes alone and in our experience can resolve 95% of these cases.
- Extracorporeal Shockwave Therapy. This is the use of high-intensity sound waves to release scar tissue, increase blood flow and improve healing whilst also reducing pain.
Treatment for long term Plantar Fasciitis
If these interventions fail (which may be the case if the problem is long-standing) other interventions include:
- Corticosteroid Injections. Last resort before surgery. Can help with pain, however, can increase the risk of the plantar fascia rupturing and will contribute to atrophy (or thinning) of the fat pad on the heel.
- Surgery such as a plantar fasciotomy, where the fascia is actually cut.
Plantar Heel Pain is a health issue that left without treatment can become debilitating. My advice is if you are suffering with this or something similar, please don’t hesitate in seeking assistance. The sooner it is addressed the sooner you can get back to doing what you love doing, pain-free.
