Perform a search on the internet for heel pain and the top "hit" will usually be related to a condition called plantar fasciitis. Much debate exists on exactly what plantar fasciitis is and whether it is truly related to inflammation. That debate is one which will continue as we continue to understand the condition more but for now let's keep it simple.
Plantar fasciitis can be viewed as an overuse injury to the origin of the plantar fascia related to excessive stress or biomechanics abnormalities of the foot (Healey and Chen, 2010).
The plantar fascia is a tight band of connective tissue situated on the bottom of the foot running from the calcaneus (heel bone) to the toes. It is important because it helps to support the structures of the foot during ambulation, helping you to progress from the moment your foot strikes the ground to the moment you bend your big toe and lift your foot. The pain of plantar fasciitis affects this process, making ambulation less energy efficient and potentially leading to problems elsewhere in the body.
With plantar fasciitis, patients will often report a pain in the heel, present after rest (for example first thing in the morning) which then eases upon walking. Generally activity is limited and for some it can be a debilitating problem. A detailed patient history can often identify a traumatic event or a change in shoes which has led to the onset of the symptoms.
Plantar fasciitis is common (Goff and Crawford, 2011) with approximately 10% of the population suffering (Crawford and Thompson, 2008). So how do we treat it?
Plantar fasciitis is on the whole self limiting - it will go away on its own. That's the good news, but if it goes on its own, why do people come to the clinic? How long it takes to resolve will differ between individuals but in some cases it could be upwards of 12 months and that is why treatment it sought.
The mainstay of treatment is stretches to the calf muscles, the muscles on the bottom of the leg below the knee and the plantar fascia itself. Stretches have been shown to provide symptom reduction and improve function.
There is also evidence for using orthoses or shoe inserts in the early stages of plantar fasciitis to help reduce pathological forces which act upon the foot, reducing compensation from biomechanical problems.
At Walk our podiatrists can fully assess the heel pain examining your biomechanics to provide the best solution for you. We will provide advice on stretching, footwear and if required issue you with a set of foot orthoses.
To complement this we can also provide foot joint and soft tissue mobilisation techniques to the foot and ankle which helps with the rehabilitation of the area.
There are lots of causes of heel pain with not all of these originating in the foot. Pain can be referred from other structures such as the lower back which cause pain in the foot. This is why it is important to see a professional to diagnose the problem and provide an evidence based management plan.
If you have any problems with your feet and legs, or questions and queries regarding your foot health then please contact us on 077 666 888 29 or 01562 51 56 61. You can also contact us via email - contact@walkfootcare.co.uk.
References:
Healey, K. and Chen, K. 2010. Plantar Faciitis: Current Diagnostic Modalities and Treatments. Clin Podiatr Med Surg 27, pp. 369–380.
Goff, J.D. and Crawford, R. 2011. Diagnosis and treatment of plantar fasciitis. American family physician 84(6), pp. 676–82.
Crawford and Thomson 2010. Interventions for treating plantar heel pain (Review). The Cochrane Library (1).
