Trying to beat that annoying heel pain? Read on

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.

What is Plantar Fasciitis?

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. 

Who Gets Plantar Fasciitis?

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.

• Age and Foot Mechanics: As we age, the plantar fascia becomes less flexible, making it more susceptible to injury. Individuals with flat feet or high arches may also be at a higher risk due to altered foot mechanics.
  
• Ankle flexibility: A lack of the ankle movement known as dorsiflexion is noted as being a risk factor for developing the condition. 
  
• Occupation and Activity Level: People who spend long hours on their feet or engage in activities that place repetitive stress on the plantar fascia, such as running or ballet, may be more prone to developing this condition.
  
• Loading: A rapid change in loading can bring on the symptoms.  Starting and running or walking program can bring on heel pain, so too can high intensity exercise programs with skipping and jumping movements. Changing to a new job on your feet can also lead to relative overloading.
  
• Poor footwear: Shoes can be a factor, particularly old ones or ones that are not the right type for the activity you are doing. Often a good place to start before orthotics.
  
• Weight gain and obesity: Excess weight puts additional strain on the plantar fascia.

How is Plantar Fasciitis Managed?

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:

• Rest and Ice: Resting the affected foot and applying ice can help reduce inflammation and alleviate pain.
  
• Footwear: Wearing supportive shoes with proper arch support can reduce strain on the plantar fascia.
  
• Stretching Exercises: Gentle stretching exercises for the Achilles tendon and the plantar fascia can help improve flexibility and reduce tension.
  
• Orthotics: Custom or over-the-counter orthotic insoles can provide additional support and cushioning.  These days, research is generally conclusive that prefabricated over the counter orthotics are just as effective as custom built ones. 
  
• Soft tissue management of lower limb muscles: Joint mobilisation and massage to help improve ankle function can be assistance. 
  
• Taping: in our clinic, we use what is known as a treatment direction test using tape to trial how the foot might respond to arch support in the form of an orthotic.  It not only helps to settle down the pain, but can provide good insight into longer term solutions.
  
• Strength and tensile exercises: a specific type of calf raise where the load is     progressively increased over the course of several months to help make the plantar fascia more accustomed to loads and increase its load capacity.  This for me is the key to a successful treatment plan and is the one thing that most of my patients have not previously done or been told to do. 

Timeline

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.