Also commonly known as plantar heal pain, plantar fasciitis is where the plantar fascia, a thick band of fibrous tissue in the sole of the foot, becomes inflamed and painful. It is thought that this arises from microscopic tears in the tissue from excessive load, leading to inflammation. It is also possible to experience heal pain arising from the plantar fascia in the absence of inflammation, hence the alternative term plantar heal pain.
The plantar fascia extends from the underside of the heel to the base of the toes and provides structural support to the arch of the foot and providing shock absorbance with load i.e. walking, running and jumping.
What are the symptoms?
Plantar fasciitis, or plantar heel pain is most typically characterised by a sharp pain or severe aching pain when load bearing, particularly the first few steps of walking first thing in the morning or when walking after being seated for a prolonged period. This pain usually subsides once the tissue has warmed up, so unless walking or standing for prolonged periods, generally pain feels better throughout the day. Usually the pain is located at the heel attachment, but can also be painful or tender to touch along the length of the tissue.
What are the causes?
The plantar fascia is similar to tendon tissue in that it is sensitive to changes in load, i.e. a sudden increase in training load when running, jumping or even walking and general time on your feet. It is common in runners due to repetitive impact associated with this activity over prolonged periods.
Other causes include inadequate footwear (either poor structural support or poor shock absorbance from a very flat, thin sole such as flip flops), altered biomechanics such as having very pronated feet (reduced arches) or even very high arched (supinated) feet due to altered load being placed on the tissue and even excess body weight being carried placing extra stress on the plantar fascia.
It was previously thought that having a bone spur on the heel bone (calcaneum) could be a cause of plantar fasciitis; however more recent research suggests that it is very common to have a heel spur and not have any pain, while the presence of heel pain in people with bone spurs is only approximately 5%.
How is it diagnosed?
Usually a good history of the presenting complaint taken by a physiotherapist is enough to diagnose plantar fasciitis. A thorough assessment of a persons symptoms, the symptom behaviour through the course of the day, common daily activities and training load will indicate whether plantar fasciitis is likely.
A physical examination is then performed which will assess the foot and ankle range of motion and function and there is usually tenderness at the insertion of the plantar fascia. The physical examination will also identify any other intrinsic contributing factors such as tightness of the calf and hamstring muscles, biomechanical issues with foot posture such as excessive pronation or supination and any restriction to foot and ankle mobility.
How is it treated?
The majority of patients with plantar fasciitis will see resolution of symptoms in 10-12 months, however, there are many ways in which you can gain relief from heel pain, including:
- stretching the calf and hamstring muscles and also the plantar fascia
- self massage using a spiky massage ball or a tennis ball
- ice to reduce inflammation and provide pain relief
- rest (reducing repetitive high load activities such as prolonged walking, running, repetitive jumping)
-non-steroidal anti-inflammatories (NSAIDs) may be helpful short term
-wearing appropriate footwear with adequate support
-using orthotics to provide corrective support to the arch and providing additional shock absorbance
-Physiotherapy to provide soft tissue release or acupuncture
A physiotherapist can advise what is necessary based on your assessment and the identification of contributing factors.
If the pain persists and is resistant to improvement with the above measures, it may be appropriate to consider either extracorporeal shockwave therapy (ESWT) or a cortisone injection.
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