Heel pain, Plantar fasciopathy or Plantar Fasciitis (it doesn’t really matter too much what we call it), is a prevalent foot condition that we see almost daily in the clinic. It can range from mild to severe and the functional impacts it has on our lives makes it one of the more annoying conditions for our patients.
Over the course of my almost 20 year career, a lot has changed in the guidelines surrounding best practice management of the condition and thankfully, in my opinion, we are now much better at managing it. However, time and time again, I continue to see patients who have been elsewhere (even so-called “Foot Doctors”) miss out on one key component of their rehabilitation.
This blog will shed some light on what Plantar Fasciopathy is, what we know about some factors that contribute to it occurring and how it is managed, including a key exercise that should be done in the majority of cases.
Plantar fasciitis occurs when the plantar fascia, a strong band of tissue that supports the arch of your foot, becomes irritated and inflamed. This inflammation can lead to heel pain, especially during the first few steps in the morning or after a period of rest or sitting. Heel pain is the most common area of pain reported but it is not the only place where symptoms can be present.
So what exactly is the plantar fascia? The plantar fascia runs from the calcaneus to the phalanges. Utilising its inherent tensile strength, it prevents the collapse of the arch of the foot upon vertical load transmission from the weight of the body.
Plantar fasciitis can affect anyone but we have learnt over the course of time that there are some factors that do tend to correlate with presentations of painful heels. Here are the main ones.
Effective management of plantar fasciopathy involves a combination of lifestyle modifications (i.e less walking), physiotherapy, and, in some cases, medical interventions.
Key aspects of management include:
In my experience, plantar fasciitis that is going to settle with physiotherapy will usually do so by around 3 months. This amount of time is usually needed to improve the capacity of the plantar fascia in regards to load and also provides a good amount for 1st toe and ankle mobility to improve.
Despite good adherence to the treatment plan, then if symptoms persist beyond 6 months I would usually be looking to refer for medical opinion and possible management using shockwave therapy, cortisones and anti-inflammatory medications.
There is very rarely ever only one thing that contributes to the development of plantar fasciitis. This means that a comprehensive treatment plan that looks at all variables is put in place. Physiotherapy is best placed to help you with this and with the right plan and a little patience, you should see improvement.
If you have been putting up with heel pain that is not going away then come and see us, we can help.
Yours in health
Chris from Out of the Box Physiotherapy.