What is Heel Pain (Plantar Fasciitis/Fasciopathy/Heel Spur Syndrome)?
The plantar fascia is a broad band of connective tissue located along the bottom surface of the foot that runs from the heel bone (calcaneus) to the forefoot (metatarsals). Plantar fasciitis is a common clinical condition caused by overuse or acute injury direct to the plantar fascia. Inflammation, thickening, and a decreased blood supply of the fascia occur, causing symptoms of heel pain. The plantar fascia acts as a rubber band to absorb shock as you walk or stand and constantly elongates and contracts. This constant stretching can result in tears in the soft tissue, most commonly occurring at the heel. This condition is clinically referred to as plantar fasciitis/fasciopathy
Symptoms of plantar fasciitis/fasciopathy
Symptoms may include:
- Burning sensations in the sole of the foot
- Recurring foot pain that is especially sore or tight in the morning or after sitting.
- Tired feet after being upright for long periods of time
- Heel pain after beginning a new exercise routine
- Pain that increases over a period of months
Causes of plantar fasciitis/fasciopathy
Heel and arch pain is usually the result of abnormal biomechanics that places too much stress on the heel bone and the soft tissues that attach to it. This increased stress causes local inflammation and pain. The most common cause of this increased stress is excessive pronation, which means that your feet roll inward too much when you walk. This is often referred to as flat feet. As they roll inward the arch of the foot flattens and the arch lengthens. When the arch lengthens there is increased tension on the plantar fascia. However, this condition can also occur in people with high arched feet.
There are numerous conditions that cause heel pain, and symptoms of one condition can be similar to that of another. Therefore it is vital that an accurate diagnosis is made by a podiatrist, in order for treatments to be effective. Some other common causes of heel pain include:
- Fat pad syndrome
- Baxter’s nerve entrapment
- Tarsal tunnel syndrome
- Achilles Tendonitis
- Calcaneal (heel bone) fracture
- Retrocalcaneal bursitis
A comprehensive clinical examination of the affected foot is undertaken to assess for possible causative and aggravating factors, the severity of the condition, and suitable treatment options. Diagnostic imaging such as X-rays and Ultrasound may also be ordered.
From these findings, a treatment plan is developed specifically for you. Some aspects of the treatment plan may include:
- Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefits such as swimming or cycling.
- Strengthening. It is important that strength is addressed for this condition so that the plantar fascia area can tolerate more load. This is done initially with isometric loading to load up the affected area in a pain-free way. When pain has reduced a strengthening program will be incorporated into the surrounding influencing muscles.
- Increase in ankle range. Poor ankle range can be a common mechanism contributing to heel pain, therefore intervention to increase ankle ROM will be implemented when necessary.
- Heat or Ice. This condition may respond better to either heat or ice. Try heat prior to exercise and Ice afterwards.
- Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
- Adequate footwear. Supportive and appropriate footwear is recommended to stabilise the foot and ankle. Avoid wearing thongs, slippers, sandals and barefoot.
- Taping/Bracing. Taping or bracing can help to stabilise the foot and ankle and reduce excessive stress on the plantar fascia.
- Orthotic therapy: A custom orthotic device placed in the shoe can help address possible causative factors such as flat feet, to reduce stress on the plantar fascia.
- Extra Corporeal Shockwave Therapy. A non-invasive treatment where shockwaves are sent into the foot to stimulate the body’s own healing process.
- Injection therapy. If conservative treatment is plateauing injection therapy may be considered for pain relief.
- AlterG Anti-Gravity Treadmill. Continuation of training on the AlterG to decrease the load on the foot and its surrounding muscles whilst maintaining an exercise program.
Surgery for plantar fasciitis/fasciopathy
Occasionally, surgery may need to be performed for chronic cases that are none responsive to conservative treatment.