We are always banging on about how a healthy body is supported by an active life, and you are listening. In the last few weeks you have decided it’s time to move that body more. Well done you. And you are feeling good for it. Woohoo!!! But now when you wake up, those first few steps in the morning are really painful. Or maybe it feels like there’s a stone in your shoe? You might have the starting signs of plantar fasciitis. Relax – things can be done! Jude Holroyd and Kaelin Moodley provide a run down on this condition.
What is it?
The plantar fascia is a thick fibrous band that extends from the base of the heel to the toes underneath our feet. It plays an important role in arch support, which is vital for walking and all other weight bearing activities.
Plantar fasciitis is a condition characterised by damage to and inflammation of the plantar fascia. This usually occurs at the inner part of the heel bone where the plantar fascia attaches.
Plantar fasciitis is one of the most common causes of heel pain seen in the clinic. It often occurs when there has been an increase in repetitive activity.
Increased strain on the plantar fascia can be caused by poor biomechanics such as running style or anatomical reasons such as flat feet or poor footwear. This can eventually cause pain under either the arch of the foot or more commonly under the heel.
Who gets plantar fasciitis?
Plantar fasciitis most commonly occurs due to repetitive or prolonged activities placing strain on the plantar fascia. It is often seen in runners, or dancers and gymnasts who perform regular activities involving end of range foot and ankle movements. It may also occur in patients who walk excessively, especially up hills or on uneven surfaces.
Clients who spend a lot of time on their feet may also develop the condition.
They call them “killer heels” for a reason.
Signs and symptoms of Plantar Fasciitis
Clients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. They will usually complain of pain after periods of rest this may be either first thing in the morning or after sitting for some time and taking the first few steps.
We are often told that the pain decreases after the client has “warmed up” either by taking a few small steps or stretching the calf, usually this is in the early stages of the injury.
As the condition progresses, clients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, clients may walk with a limp or be unable to weight bear on the affected leg.
Clients with this condition may also experience swelling, tenderness on firmly touching the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.
Contributing factors to the development of Plantar Fasciitis
There are several factors which can predispose patients to developing plantar fasciitis. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- poor foot posture (especially flat feet)
- foot or ankle stiffness in the forefoot, midfoot or ankle joint
- muscle tightness (particularly in the calf and the plantar fascia itself)
- inappropriate or excessive training
- being overweight
- poor biomechanics (excessive pronation/ supination/ poor/ incorrect running technique)
- inappropriate footwear (worn out shoes, poor arch support)
- inadequate warm up (calf stretches)
- muscle weakness
- leg length differences
- poor proprioception or balance
- poor core stability
Other causes of heel pain
Is your heel pain in the same region but doesn’t sound quite like plantar fasciitis?
There are a few other causes of heel pain, these include;
- Fat pad atrophy
- Tibialis Posterior, Flexor Hallucis Longus or achilles tendinopathy
- Baxter’s nerve neuropathy
- Plantar fascia tear
- Stress fractures
As you can see there is a lot that could be affected when you have heel pain. One of our physiotherapists will do a thorough assessment to ensure that you are on the right path to recovery!
Is it going to get better?
Most patients with this condition heal well with appropriate physiotherapy. Minor cases of plantar fasciitis that have not been present for long can usually recover within a few months. In patients who have had their condition for a long period of time, recovery can be lengthy. Early physiotherapy treatment is therefore vital to assist in recovery.
A 47 year old man presented to us after having heel pain for 12 months. He had previously seen a podiatrist who prescribed orthotics and calf strengthening exercises. Over this time he had minor improvement to his pain levels.
Upon examination it was confirmed that the patient had plantar fasciitis.
It was also evident that the patient was doing significantly more running over the last 18 months and continued this activity once seeing the podiatrist.
As explained previously there are lots of factors that can contribute to plantar fasciitis. The previous treatment he received was not wrong, however his activity levels were not reduced enough.
Our treatment entailed deep tissue massage, taping and shockwave therapy. In conjunction with education regarding decreasing exercise/running load, this patient made significant improvement with physiotherapy quite quickly.
Despite having plantar fasciitis for some time, this patient was pain free and back to full activity in 4 months.
Don’t let this frustrating condition stop you from doing the things that bring you joy. Our physios are more than happy to get you on the right path to recovery!