Heel Pain and Plantar Fasciitis
Heel Pain and Plantar Fasciitis are common foot problems that can be very disabling as pain is felt on walking, standing up after sitting, and when getting out of bed. Luckily, most heel pain settles with appropriate treatment and time. The American Orthopaedic Foot and Ankle Society states that “wearing standard orthotics and doing daily exercises, allows 95% of patients to experience substantial, lasting relief from their heel pain symptoms.”
Plantar Fasciitis displays inflammation, micro-tears, and scarring under the foot, usually related to overstretching or unaccustomed use. The thick band of fascial tissue runs from your heel to your toes. It while usually flexible and strong, it gains support from deep intrinsic foot muscles. Its function is to absorb load and stress, and to allow flexibility and strength to your gait. Ultrasound assessment may reveal tears or swelling but is usually not needed prior to treatment.
Heel pain is felt more directly under your heel where the plantar fascia attaches into bone. Pain arises when the fascia pulls at the attachment to the heel bone. Irritation and inflammation occur. A Heel Spur, bony growth, may be seen on X-RAY indicating chronic pulling at the facial attachment; however, this may be painless. X-RAYS are not needed.
People usually feel sharp pain in the heel and fascia with general foot stiffness when getting up in the morning or after resting. Pain often subsides to a dull ache, with sharper pain during and after walking.
Plantar Fasciitis arises from multiple factors:
- Poor foot biomechanics (over-pronation)
- Aged > 45 years
- Being overweight or pregnant
- Too much of a new activity, too soon
- Playing sports on hard surfaces
- Wearing shoes that are too tight or too sloppy
- New shoes that are too hard
- Prolonged standing and walking particularly on hard surfaces
- Sedentary lifestyle and inactivity
- Tight calf muscles
- Badly worn shoes with little support,
Treatment for Heel Pain and Plantar Fasciitis
Early physiotherapy treatment combined with modification of your activities and shoes help this problem to settle.
- Mobilisation techniques help improve the gliding motion of the heel joint to reduce strain on the fascia
- Taping of the foot and heel in a stable position to unload and protect tissues,
- Add a heel cup, soft shock-absorbing heel pad or orthotic to your shoe, to reduce pain,
- Stretch calf muscle and toe extensors daily
- Immerse your foot in a bucket of icy water for 5 – 10 mins three times a day
- Rolling your foot on a frozen can of drink can decrease inflammation and pain
- Rest and minimise weight bearing activity, walking, running and sports
- Lose weight
- Improve intrinsic muscle endurance and strengthening exercises
- Practice Tibialis Posterior Supination to protect against foot overpronation and hip internal rotation
- See a Podiatrist for assessment and correction of abnormal foot mechanics
- Anti- inflammatory medications may help
- ESWT (Extra Corporeal Shockwave Treatment) targets the affected heel area to stimulate healing and reduce inflammation and pain. May take from three to 4 months to be fully effective.
- Cortisone-steroid injections by a GP or ultrasound guidance