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Plantar Fasciitis - A Real Pain In The Heel

How is your plantar fascia?
image Not a question you tend to get asked often but as 10% of us will suffer heel pain at some point during our adult life, you may well know something about this structure.
The plantar fascia is the dense fibrous membrane that spans the underside of the foot from the calcaneus, or heel bone, to the toes. This structure is in three sections and helps to support the arches of the foot and provide dynamic shock absorption when we walk and run.

So what causes plantar fascia pain and how can it be helped?
What is plantar fasciitis?
Plantar fasciitis is the name given to the condition where the plantar fascia is painful. We used to think that the pain came from inflammation, hence the letters "itis" at the end. However, research into the pathology of this condition has found that the tissues of the plantar fascia degenerate but are not inflamed. This means that the pain felt comes from microtears within the fibrous membrane across the sole of the foot. The most common place for the pain to be felt is on the medial side of the heel bone.
What factors cause it?
Current thinking is that plantar fasciitis is caused by overuse. Cumulative stress to the plantar fascia causes microtrauma. Certain factors will contribute to this process and these factors all affect your biomechanics, affecting the way your feet function. These include:-
  • Limited ankle movement - tight calf muscles, stiff ankle joint
  • Inappropriate footwear - poor support for foot, poor shock absorption
  • Leg length difference - one leg a little longer than the other
  • Hard surfaces for playing sport
  • Prolonged standing / walking at work
Of these, reduced ankle movement may be the most important risk factor as 70% of patients with plantar fasciitis are found to have a stiff ankle or tight calf muscles.
What symptoms will I have?
Pain is often of gradual onset with no clearly identifiable cause. Patients often describe a "deep ache" or a "bruised feeling" at their heel and arch of the foot. This pain is much worse with the first few steps of the morning. Initially this pain may get better with activity and movement but as the degeneration gets worse, the pain will also get worse. Typically, getting up after sitting at your desk at work is painful. There is often a point on the inside of the heel bone which is very tender to touch.
What else could it be?
Not all foot pain is due to plantar fascia problems. It is always very important to consult your Physiotherapist, Podiatrist or GP to rule out other conditions such as:-
  • Stress fracture of the heel bone
  • Referred pain from the lumbar spine / sacro-iliac joint
  • Toe flexor tendon pain
  • Sever's Disease - heel pain affecting 8 - 15 year olds
What treatments help?
Treatments for plantar fasciitis are based on the following aims to:-
  • Control pain
  • Ensure good flexibility of the plantar fascia
  • Identify and correct any contributing factors
  • Phase back to activities safely
Stretches, local massage and mobilising techniques are used to help the plantar fascia regain normal flexibility and to help the tissues regain the strength to cope with loads again. Any factors contributing to the development of plantar fasciitis should be identified and corrected. This may include stretches for the calf muscles, advice on footwear or the provision of special in-soles called orthotics to help your foot function correctly.

To get better, it is important to treat both the pain and the causes. This is why the Physiotherapy staff at McNaughton Clinic work closely with our Podiatry and biomechanics colleagues to ensure that all contributing factors are identified and corrected. Plantar fasciitis is a real pain in the heel but with the right help, it needn't be!

This article was written by the McNaughton Physiogrange Team and first appeared in the October 2010 edition of the 702 Gazette

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