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Plantar fasciitis (Heel Pain)



How to say it?

Plantar fasciitis is a bit of a 'Worcester Sauce' name; everyone knows it but not many know how to pronounce it. The full pronunciation is ‘Plan-tar-fa-shee-eye-tus’


What is it?

Plantar fasciitis is a condition, but thanks to Dr Google it has become an umbrella term for all types of heel pain. The name means inflammation of the plantar fascia which is a structure that runs from the heel to the toes.


Symptoms

  • It feels like something under the foot wants to snap.

  • Pain can be anywhere along the plantar fascia though it is usually in the heel.

  • Pain is worse 1st thing in the morning or after a period of rest but eases after few minutes.

  • The day after a lot of exercise can be particularly painful.

  • Its ok when walking the dog or playing golf but after a brew or pint it feels painful.


Causes


Plantar fasciitis rarely has a single cause, and it is almost impossible to predict who will get it. However, the following are factors that are associated with it:

  1. High impact forces from walking on hard surfaces, especially if safety boots or shoes with little to no cushioning are worn.

  2. Stiff ankles.

  3. Reduced fat pad under the heel and standing for long periods. Standing causes heel fat to compress in the same way that a cushion compresses if you sit in it. This leaves the heel with little natural protection.

  4. Increasing exercise without allowing time for the tissues in the body to adapt or running with a heavy heel strike.

  5. Body weight. Low body weight can lead to reduced fat pads. Being over-weight leads to increased forces on the feet especially when walking and running where forces are amplified.


Treatment


All treatment should revolve around making the body stronger and more capable. This means exercise!!

Exercise helps to reduce pain and stimulates injured tissues to become stronger. As tissues gain strength, they become more resistant to stress, making them less prone to injury.


Short Term


These treatments are primarily for reducing pain and making life more comfortable:

  • Low dye tape. This helps to contain the fat pad and reduces tensile stress on the plantar fascia.

  • Massage and rolling. Helpful for short term pain relief, but they do not stimulate the tissue to become stronger. If more exercise can be done because of massage, then there will be an improvement in strength BUT it’s the exercise not the massage that helps.

  • Stretching. Stretching applies a very low tensile stress to the plantar fascia and can improve range of motion in the foot and ankle joints. It can help reduce pain, but the effect is only short lived.

  • Cushioning. Adding more cushioning to shoes can help reduce impact forces. This is particularly helpful if you have reduced fat pads or wear hard soled safety boots.


Medium Term


At this stage pain should be more bearable. The focus of rehab shifts to building strength rather than pain management. Treatment will vary depending on who is being treated e.g. I would not expect an 80-year-old lady with joint replacements to complete the same rehab plan as a 25-year-old marathon runner.

  • Strength exercise. We aim to build strength through the whole body but pay particular attention to muscles and structures below the knee.

  • Foot orthoses. These are special insoles that help improve the way the foot works. They also reduce stress on injured tissues. The aim is to make exercise more comfortable so you can do more exercise with less pain. As exercise tolerance builds, we can reduce the effect of the orthotic.


  • Gait retraining. Changing the way, you run to reduce heel impact and stress on the plantar fascia. This sounds complicated but is easier than you may think.

  • Address lifestyle issues. We start to address issues such as sleep and diet both of which have a huge effect on pain and body weight.


Long Term


Pain may still be present at this stage but will not be causing any major issue. The aim is to continue building strength and resilience to prevent recurrence.

  • Strength and sport specific exercise. More dynamic than the medium-term exercises and have a whole-body emphasis rather than foot and ankle focus.


  • Foot orthoses. At this stage we start reducing the need for orthoses.

  • Address lifestyle issues. Continue to build good habits for diet, sleep, and exercise.


Ultimately if you are suffering from plantar fasciitis which isn't improving, look for an MSK podiatrist who provides an exercise rehab plan.

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Without this element the problem is likely to recur. The strength exercises encourage tissues to cope better with the stress placed upon them.


Andrew Ayres, MSK Podiatrist at Ayres Health.

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