Plantar Fasciitis (Plantar Heel Pain) is very common.
In fact 1 in 10 Townsville people will experience it at some time during their lifetime.
It often affects middle aged people and women and can make walking extremely difficult, especially first thing in the morning.
Fortunately, Townsville Podiatry can help alleviate your pain!
In fact 1 in 10 Townsville people will experience it at some time during their lifetime.
It often affects middle aged people and women and can make walking extremely difficult, especially first thing in the morning.
Fortunately, Townsville Podiatry can help alleviate your pain!
What is the Plantar Fascia?
The plantar fascia is a very strong ligament that attaches underneath the heel bone, fanning out and extending forward to attach to the toes. It supports the arch of the foot and act as a spring mechanism to propel you forward when you walk or run.
It literally puts the spring in your step!
Plantar Fasciitis is a term used to describe when the plantar fascia gets irritated. We used to think it was inflammation of the fascia that caused the pain, but we now know this is not the case. Thickening and degenerative changes of the tissue are the cause of the pain. This why you may see the terms plantar fasciopathy, or even plantar heel pain used.
Why is my Plantar Fascia irritated?
The plantar fascia becomes irritated when there is an imbalance between load on the fascia and it's capacity to withstand the load.
Examples of increase load could be you changed jobs and are now standing more than you did before, or it could be a change in your running training, with an increase of distance, frequency, or speed. Maybe you've changed shoes to a less supportive pair than you had been wearing previously?
Increased body weight can also increase load on the plantar fascia - no wonder so many many pregnant women have heel pain!
Sometimes though, there may have been no change in load at all. This means that the capacity of the plantar fascia to withstand the 'normal' load has reduced.
Reduced capacity of the plantar fascia can be influenced by stress, increasing age, or changes in hormone levels. This may be why plantar heel pain is so common in peri-menopausal women.
Biomechanical factors also play a role, with both flat feet and high arches associated with plantar fascia irritation as well as tight calf muscles.
I've been told I have a heel spur, isn't that what's causing my heel pain?
Probably not. According to a recent study heel spurs don't affect pain or function of the plantar fascia, no matter how big or what shape the spur is.
So it's not the heel spur that hurts but the plantar fascia itself or other soft tissue structures in the area.
Other fun facts
10% of the population have heel pain yet 15% of the population have a heel spur
Also
The heel spur forms where the plantar fascia and other small foot muscles attach onto the heel bone, so can be an area of tractional stress. Heel spurs have been also associated with a reduction in the elasticity of the heel pad. Walking can be very uncomfortable on a heel pad that is not very elastic. Sometimes neural pain can occur if the lateral plantar nerve gets compressed on the heel spur.
The plantar fascia is a very strong ligament that attaches underneath the heel bone, fanning out and extending forward to attach to the toes. It supports the arch of the foot and act as a spring mechanism to propel you forward when you walk or run.
It literally puts the spring in your step!
Plantar Fasciitis is a term used to describe when the plantar fascia gets irritated. We used to think it was inflammation of the fascia that caused the pain, but we now know this is not the case. Thickening and degenerative changes of the tissue are the cause of the pain. This why you may see the terms plantar fasciopathy, or even plantar heel pain used.
Why is my Plantar Fascia irritated?
The plantar fascia becomes irritated when there is an imbalance between load on the fascia and it's capacity to withstand the load.
Examples of increase load could be you changed jobs and are now standing more than you did before, or it could be a change in your running training, with an increase of distance, frequency, or speed. Maybe you've changed shoes to a less supportive pair than you had been wearing previously?
Increased body weight can also increase load on the plantar fascia - no wonder so many many pregnant women have heel pain!
Sometimes though, there may have been no change in load at all. This means that the capacity of the plantar fascia to withstand the 'normal' load has reduced.
Reduced capacity of the plantar fascia can be influenced by stress, increasing age, or changes in hormone levels. This may be why plantar heel pain is so common in peri-menopausal women.
Biomechanical factors also play a role, with both flat feet and high arches associated with plantar fascia irritation as well as tight calf muscles.
I've been told I have a heel spur, isn't that what's causing my heel pain?
Probably not. According to a recent study heel spurs don't affect pain or function of the plantar fascia, no matter how big or what shape the spur is.
So it's not the heel spur that hurts but the plantar fascia itself or other soft tissue structures in the area.
Other fun facts
10% of the population have heel pain yet 15% of the population have a heel spur
Also
- 1 in 2 people with painful heels don't have a heel spur
- conversely, 1 in 2 people with heels spurs don't have heel pain.
The heel spur forms where the plantar fascia and other small foot muscles attach onto the heel bone, so can be an area of tractional stress. Heel spurs have been also associated with a reduction in the elasticity of the heel pad. Walking can be very uncomfortable on a heel pad that is not very elastic. Sometimes neural pain can occur if the lateral plantar nerve gets compressed on the heel spur.
What are the symptoms of plantar heel pain?
If you've ever had plantar heel pain you know how difficult walking first thing in the morning can be! Many patients describe hobbling to the bathroom, as though they are walking on glass, avoiding walking on the heel at all costs. You may also have first step pain after you have been sitting for a long period of time. Often you will find the discomfort eases after 5-10 minutes of walking.
If you have had the heel pain for several months you might find that you also have some pain or discomfort at the end of the day.
You will feel the pain under the heel where the plantar fascia attaches to the heel bone (calcaneus). Sometimes it can extend into the arch of the foot or up the side of the heel pad.
Other causes of plantar heel pain can include:
How long will it take to get better?
The prognosis can vary significantly, from weeks to months. Definitely the sooner you start treatment the better.
You have a better prognosis if you:
It will take longer to get better if you:
Do I have to have orthotics?
No, not necessarily.
Treatment options
We can start improving your pain immediately by:
Depending on your symptoms, foot function and how you respond to treatment, orthotics can be a handy tool to manage heel pain.
If I need orthotics, what sort of orthotics are best for heel pain?
The type of orthotic best for you will depend upon you, your symptoms and why your heel is sore.
Options include:
What about a cortisone injection?
The jury is out when it comes to the role of cortisone and the management of heel pain.
Research published in 2017 in a Cochrane Review concluded there was 'Low quality evidence that local steroid injections may slightly reduce heel pain for up to one month'. (Cochrane Reviews are considered the best of the best when it comes to evidence based research for healthcare.)
So is it worth it? You've got to consider the risk vs the reward.
Cortisone injections can be very uncomfortable to have, they might provide a slight, short-term pain relief for about 4-8 weeks, but there is also a small risk that cortisone injections increase the chance of rupturing the plantar fascia..
If you've ever had plantar heel pain you know how difficult walking first thing in the morning can be! Many patients describe hobbling to the bathroom, as though they are walking on glass, avoiding walking on the heel at all costs. You may also have first step pain after you have been sitting for a long period of time. Often you will find the discomfort eases after 5-10 minutes of walking.
If you have had the heel pain for several months you might find that you also have some pain or discomfort at the end of the day.
You will feel the pain under the heel where the plantar fascia attaches to the heel bone (calcaneus). Sometimes it can extend into the arch of the foot or up the side of the heel pad.
Other causes of plantar heel pain can include:
- Fat Pad contusion
- Fat Pad atrophy
- Calcaneal stress fracture
- Neuropathic pain
- Calcaneal bursitis
How long will it take to get better?
The prognosis can vary significantly, from weeks to months. Definitely the sooner you start treatment the better.
You have a better prognosis if you:
- Start treatment within 7 month of having symptoms
- Only have one heel affected
- Are male
- Are under 41 years old
It will take longer to get better if you:
- Start treatment after having pain for more than 7 months
- Have pain in both heels
- Are female
- Are older than 41 years
Do I have to have orthotics?
No, not necessarily.
Treatment options
We can start improving your pain immediately by:
- Adding a morning warm up routine for your feet
- Strengthening the foot arch muscles
- Strapping the foot to decrease pressure on the heel
- Stretching the plantar fascia and calf
- Modifying your activity
- Giving advice about appropriate shoes
- Shockwave is useful in the management of chronic plantar heel pain
Depending on your symptoms, foot function and how you respond to treatment, orthotics can be a handy tool to manage heel pain.
If I need orthotics, what sort of orthotics are best for heel pain?
The type of orthotic best for you will depend upon you, your symptoms and why your heel is sore.
Options include:
- Silicon gel heel cups
- Soft arch supports
- Custom made soft orthotics
- Custom made firm orthotics
What about a cortisone injection?
The jury is out when it comes to the role of cortisone and the management of heel pain.
Research published in 2017 in a Cochrane Review concluded there was 'Low quality evidence that local steroid injections may slightly reduce heel pain for up to one month'. (Cochrane Reviews are considered the best of the best when it comes to evidence based research for healthcare.)
So is it worth it? You've got to consider the risk vs the reward.
Cortisone injections can be very uncomfortable to have, they might provide a slight, short-term pain relief for about 4-8 weeks, but there is also a small risk that cortisone injections increase the chance of rupturing the plantar fascia..
READY TO BE PAIN FREE?
See the links below if you're keen for further reading
Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial, Journal of Physiotherapy, July 2019, Riel H et al
Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database of Systematic Reviews 2017, Issue 6 David JA, Sankarapandian et al
The effect of isometric exercise on pain in individuals with plantar fasiopathy: A randomized crossover trial. Scandinavian Journal of Medicine & Science in Sports, Dec 2018, Riel H et al
Is 'plantar heel pain' a more appropriate term than 'plantar fasciitis'? Time to move on. British journal of Sports Medicine, Nov 2017 , Riel H et al
The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations . Journal of Anatomy 2017 June, Kirkpatrick J et al
Relationship and classification of plantar heel spurs in patients with plantar fasciitis. Foot and Ankle International Sept 2016, Ahmad J,
Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database of Systematic Reviews 2017, Issue 6 David JA, Sankarapandian et al
The effect of isometric exercise on pain in individuals with plantar fasiopathy: A randomized crossover trial. Scandinavian Journal of Medicine & Science in Sports, Dec 2018, Riel H et al
Is 'plantar heel pain' a more appropriate term than 'plantar fasciitis'? Time to move on. British journal of Sports Medicine, Nov 2017 , Riel H et al
The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations . Journal of Anatomy 2017 June, Kirkpatrick J et al
Relationship and classification of plantar heel spurs in patients with plantar fasciitis. Foot and Ankle International Sept 2016, Ahmad J,