A SPORTS PODIATRISTS GUIDE TO PLANTAR FASCIITIS & HEEL PAIN
Emily Smith explains the in’s and out’s of the most commonly experienced foot pain: plantar fasciitis.
If you asked members of your F45, run club, work team and family, you’d be surprised how many people suffer (or have previously suffered) with plantar fasciitis. Often beginning as an annoyance in the morning, this pain can quickly transcend into a debilitating sharp pain, preventing normal weight bearing until the foot ‘warms up’. If this sounds awfully familiar, chances are you too could be suffering with Plantar fasciitis (pronounced plantar fas-ci-i-tis). With hallmark symptoms of pain first thing in the morning, after rest, and with prolonged periods of standing and exercise, plantar fasciitis can be located in the heel, the arch of the foot, and rarely at the attachment into the ball of the foot.
“As plantar fasciitis becomes more chronic, pain becomes more consistent throughout the day and begins to affect daily activities, exercise routines, footwear choice, motivation and weight management.”
What Causes Plantar Fasciitis?
The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot onto the ball of the foot. The easiest way to think about it is like a rubber band under the arch that elongates and contracts. When your plantar fascia becomes inflamed, it is diagnosed as plantar fasciitis.
Plantar fasciitis can flare up following an acute injury i.e. soft sand running or stepping awkwardly off a curb, or can develop over time with overuse. If there is an acute incident, a plantar fascial tear may need to be ruled out via Ultrasound, particularly if there is bruising and swelling. The development of overuse plantar fasciitis can be related to:
poor footwear (summer sandals, flip flops, ballet flats, flat sneakers etc)
poor foot biomechanics (over and under pronation, weak intrinsic foot muscles)
weight gain (such as during pregnancy and postpartum)
exercise load errors (an acute increase in exercise or walking over a short period of time)
is often a combination of the above.
Other causes of Arch / heel pain to be Considered.
Calcification of the heel bone, known as heel spurs, are often identified on X-ray (literally look like a spur of bone protruding from under of the heel) however they are not usually the cause of chronic symptoms until there is an onset of plantar fasciitis. Heel spurs can be a sharp, knife-like pain in the heel when direct pressure is applied to the heel, or can be a bruising-type pain that presents more towards the end of the day. Walking barefoot on hard surfaces, or wearing hard soled shoes or hard orthotics can irritate a heel spur. Heel spurs often cause inflammation of the fat pad under the heel area and this can also contrite to heel pain. It is important that if a heel spur or fat pad inflammation is suspected that a donut padding is applied to the orthotic or footwear to permanently unload pressure on the heel spur.
Other forms of foot and heel pain to be excluded include tendinopathies, stress fractures, spondyloarthritis, tarsal coalitions, soft tissue tears, spring ligament tears, bursitis and nerve entrapments.
How is Plantar Fasciitis Diagnosed?
The diagnosis of plantar fasciitis is usually based on symptoms, history and clinical examination. A walking and running gait assessment is used to identify symptom patterns, foot and lower limb biomechanics, footwear, weaknesses and form. If further investigation is required to clarify diagnosis or identify the extent of a tear / heel spur, an Ultrasound plus x-ray, or an MRI may be warranted. Pathology tests (including screening for HLA B27 antigen) may be warranted if inflammatory arthritis is suspected.
What is the Best Treatment for Plantar Fasciitis?
“The truth bomb? As a general rule, if you’ve had it for 2 months, it will take 2 months to resolve after the initiation of good management. Similarly, if you’ve had it for 2 years, it will take 2 years to resolve. In a nut shell, the more chronic, the longer it takes to resolve due to the healing process that is required.”
The good news is, plantar fasciitis is completely treatable once a good management plan is in place and adhered to. There are two phases of plantar fasciitis, the inflammatory phase (acute pain in the mornings) and the healing phase (low grade pain in the mornings). A successful management plan can reduce the inflammation quickly and begin the healing phase (which takes the bulk of the time) where pain levels become more manageable.
Tested ways for successful management of the inflammatory phase of plantar fasciitis:
Strapping of the foot to improve the foot biomechanics and de-load the plantar fascia
Change of footwear to more supportive styles
Exercise modification (opt for less impact on the feet)
Calf muscle stretches throughout the day and any other stretches that are required to improve biomechanics
Rolling the foot over a tennis ball first thing in the mornings
Rolling the foot over an ice bottle in the mornings and after exercise
10 x calf raises first thing in the morning
Prescribed customised flexible orthotics with features to improve foot function, unload the plantar fascia and cushion heel spurs
Release of the plantar fascia via massage
Physiotherapy for manual therapy and proximal chain exercises as required
Tested ways for successful management of the healing phase and prevention of recurrence of plantar fasciitis:
Continued rolling of the foot in the morning and after exercise
Increased calf strengthening program
Prescribed customised flexible orthotics to improve foot function, unload the plantar fascia and heel spurs
Active foot strengthening exercises and any other exercises required to improve the lower limb muscle strength and flexibility via Physiotherapy
Running technique modification
Standing and walking posture improvement
Exercise / load education and management including a safe return to prior activity loads
Insoles to support the foot and cushion the heel in fashionable footwear (Emily Braidwood footbeds coming soon)
Limiting use of aggravating footwear and minimising / addressing other risk factors
No two cases are the same and therefore the treatment of plantar fasciitis, as well as the timeframes, vary from person to person. Overall, with treatment you should expect that your pain will become far more tolerable, and exercise tolerance will be greater. This should continue to improve with time and program adherence. If your pain does not change within a reasonable timeframe, or pain management plateaus, further investigation may be warranted (as per above) or via a Sports Physician and potentially more aggressive forms of treatment may be required such as injection therapy. Other forms of management can include shock wave therapy and night splinting.
“Our team of sports podiatrists are highly-skilled in the assessment, diagnosis and management of plantar fasciitis. It is essential to have an experienced clinician thoroughly assess and correct your foot and leg biomechanics to ensure effective and efficient management as well as to prevent future plantar fasciitis episodes.”
For more specific advice about your plantar fasciitis, please contact your nearest Sports Podiatrists locations or email us email@example.com. If this sounds like someone you know, please share.
Written by Emily Smith.