Heel Pain /
Plantar Fasciitis

What is the Plantar Fascia?

• The plantar fascia is a thick fibrous ligament that runs under the foot from the heel bone and fans under the arch to attach to the base of the toes
• The function of the plantar fascia is to help arch the foot by tightening like a pulley as the toes bend during push-off with walking or running
• It acts as a natural shock absorbing mechanism
• It is not very elastic so has a limited ability to stretch or elongate
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What is a Heel Spur?

• A Heel Spur is a bony growth on underside of the heel bone (calcaneus)
• It is a type of calcification thought to develop as a response to constant traction and pulling of the plantar fascia on the heel bone
• An x-ray will clearly show a heel spur
• The spur is not painful, the pain is caused because of the inflammation of soft tissue around the heel
• Many people suffer with Plantar Fasciitis and do not have a heel spur and vice-versa
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What is Plantar Fasciitis?

• Plantar Fasciitis is also referred to as Heel Spur Syndrome
• It is a very common condition seen by Podiatrist – approximately 1 in 10 people affected in their lifetime
• It is susceptible to reoccur
• It is an inflammation of the plantar fascia resulting in irritation and pain
• When too much stress is placed on the plantar fascia then micro-tearing will occur
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Symptoms:

• Typically, pain is in and around the heel where the plantar fascia attaches. Some people experience pain under the arch of the foot also
• It can affect one or both heels
• The pain typically feels like a ‘bruised’ heel
• Generally worse in the morning on getting out of bed – during rest the plantar fascia shortens and tightens
• Improves as the foot warms up with walking as the plantar fascia becomes more flexible
• Pain during the day from periods of rest to standing
• Walking long distances or increased standing is likely to cause the pain to return

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Causes:

• Strain on the plantar fascia can occur either by acute or chronic injuries
• Acute injury to the plantar fascia is where there is an incident of a stretch injury to the arch of the foot
• Chronic injury to the plantar fascia is repetitive strain and can be the result of many factors including:
  - Overuse: sports, running, walking or standing for long periods
  - Age: more common in people over 40 years of age
  - Weight gain: more pressure on bones, joints, muscles and ligaments
  - Occupation: jobs with a lot of walking or standing on hard floors
  - Poor footwear: with inadequate support
  - Foot Biomechanics: both high arched and low arched or pronated feet can be prone to Plantar Fasciitis

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Treatment  

Get Treatment Early to Prevent Plantar Fasciitis Becoming a Chronic Condition

Effective treatment is aimed at reducing strain and therefore inflammation in the plantar fascia. This can be done by:

• Strapping – to support the arch and take load from the plantar fascia and the heel
• Compressive foot sleeves – help reduce inflammation
• Stretching – of the plantar fascia and calves
• Strengthening – of the calf muscles and internal muscles of the foot
• Footwear – avoid being barefoot or wearing soft shoes or thongs. Wear more supportive lace ups or runners
• Orthotics – your Podiatrist can discuss the most effective orthotic device to improve your foot biomechanics to help offload the plantar fascia
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It is also important to reduce the inflammation in the plantar fascia. This can be done by:

• Rest – with feet elevated to reduce swelling
• Cold packs – to constrict blood vessels to reduce blood flow and inflammation
• Anti-inflammatory medication – seek medical advice
• Cortisone injections – can aid in the reduction of inflammation. Beware as can cause tissue and fat pad atrophy
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Dry needling/Shock wave therapy can be useful in chronic cases of Plantar Fasciitis to help increase blood flow to the area and stimulate the repair process of the ligament