Plantar fasciitis (heel pain)
Plantar fasciitis (pronounced PLAN-tur fas-e-I-tis) is the most common cause of persistent heel pain. The condition is one that usually gets better on its own but it can be persistent and take between 6 and 12 months to resolve. There are a few things that you can do to help yourself (as well as see a physiotherapist) during that time. Read on to learn more ……..
About plantar fasciitis
The plantar fascia is a thick, web-like ligament that connects your heel to the front of your foot. Its role is to support the arch of your foot when walking and to act as a shock absorber. As you can imagine the plantar fascia experiences a lot of wear and tear during your daily life and too much pressure on your feet can damage or tear the ligaments. We used to think that the plantar fascia became inflamed and the inflammation caused heel pain and stiffness. However recent studies have suggested that the condition may involve degeneration (or wear and tear to the tissue) rather than inflammation. The word “fasciitis” means “inflammation of the fascia” so a more accurate name may be plantar fasciosis or plantar fasciopathy.
There can be many other causes of heel pain such as nerve, bone and tendon problems in the foot and associated conditions such as rheumatoid arthritis. If there hasn’t been a specific diagnosis for your pain your health professional may call it “plantar heel pain”.
What causes plantar fasciitis?
There are numerous factors which can contribute to someone’s risk of developing plantar fasciitis. These include:
• Being overweight or obese increases the pressure on your plantar fascia (especially if you suddenly gain weight).
• Active men and women between the ages of 40 and 70 are at the highest risk for developing plantar fasciitis.
• Having high arches in your feet or being flat-footed and other structural foot problems may result in the development of plantar fasciitis.
• Long-distance runners or high impact activities such as jumping and dancing put stress more the plantar fascia making it more likely to develop plantar fasciitis. Around one in 10 people who regularly run experience the condition.
• Spending a lot of time on your feet, for example, if you have a very active job such as working in a factory.
• Women who are pregnant can experience bouts of plantar fasciitis, particularly in late pregnancy due to the temporary weight pain. Hormones associated with your pregnancy can also cause your ligaments to relax.
• Wearing poor footwear with a lack of arch support and soft soles can also contribute to plantar fasciitis – we often see an increase during the summer months due to people wearing flat unsupportive flip flops!
What are the symptoms of plantar fasciitis?
The main symptom of plantar fasciitis is pain at the bottom of your heel, or sometimes in the arch of your feet. It usually affects just one foot, but it can in one in every three people, affect both feet. The pain may develop gradually over time and can be dull or sharp. Some people report a burning or ache on the bottom of their foot extending from their heel which can cause them to limp or be reluctant to put their heel down when walking. The pain is often worse on a morning when you take your first few steps getting out of bed. It has often been described as “Like walking on glass”. Similar symptoms can be experienced after you have been inactive for a while and get up from sitting or lying down.
Pain may also flare up after you have been doing a prolonged activity such as walking or running – sometimes after you have finished the activity rather than during it. Some people report that their symptoms are worse initially on walking but can then ease.
You may also find that your pain is made better or worse depending on the type of footwear you have on. Typically worse in a flat unsupportive shoe (like wellies) and better in good footwear like a pair of trainers.
Diagnosing plantar fasciitis
Your physiotherapist will usually be able to diagnose plantar fasciitis by asking you questions about your symptoms and examining your foot. They will also ask you about your general health and the sort of activities that make your pain better or worse. The physiotherapist examining you will check your foot positioning as well as the movements of your foot and ankle and feel for tenderness by pressing in certain areas. This is to make sure that the pain isn’t a result of a different foot problem. The physiotherapist will also ask you to perform some simple tasks such as balancing on each leg and observe your walking.
Sometimes, your physiotherapist may recommend you have an X-ray or ultrasound to rule out other causes, such as a bone problem. You don’t always need further tests or scans to diagnose plantar fasciitis though. We are able to offer quick access to ultrasound scanning by one of our physiotherapists here at Roundwood Health Clinic.
How can I treat my plantar fasciitis?
The majority of people with plantar fasciitis find that they make a complete recovery within about six months with following the correct advice. You need to stick with the recommendations and follow any exercises you have been given for 6-8 weeks though before you may notice any improvements in your symptoms.
• Make sure you are wearing good supportive shoes – trainers with laces are one of the best options, but your physiotherapist can give you further advice about footwear.
• Modify your activities so that you can allow your foot to rest by taking regular breaks from walking for example and reduce the length of time you are on your feet whenever possible.
• You may need to take time off from certain high impact exercises (such as running) if these activities are causing pain. Sometimes running on a softer surface can help and when you return to running make sure you start slowly. It can be a good idea to switch to low impact activities to allow the plantar fascia time to heal such as swimming or cycling.
• Your physiotherapist will provide you with an individual programme of initial stretches for the plantar fascia, calves and surrounding muscles. These will gradually be progressed to “loading” exercises for the plantar fascia which in recent studies has been shown to be an effective treatment for plantar fasciitis.
• Apply an ice pack or a frozen bottle of water (wrapped in a towel) to your heel area for 15-20 minutes a couple of times a day.
• Your physiotherapist may recommend the use of gel heel pads or orthotics to help alleviate some of the pain by distributing pressure. We are able to offer a bespoke orthotic assessment and provide you with some orthotics here at Roundwood Health Clinic.
• Do your best to stay at a healthy weight or if you are offer advice try to lose weight to reduce the pressure on your plantar fascia. Your physiotherapist can give you some advice on the safest ways to exercise in order to help you with this.
• Try not to be barefoot at home – even first thing on a morning and keep some supportive footwear to use inside the house.
• Taping and strapping may be recommended by your physiotherapist to take some of the load off the plantar fascia.
• Speak to a pharmacist for advice regarding over the counter pain-relieving medication.
Other treatments for plantar fasciitis
You will need to continue with your stretches and advice for a few months to see an improvement in your symptoms. If, however, after this timescale your symptoms are not changing or your pain is severe and affecting your day to day function your physiotherapist may speak to you about other treatment options. These may include:
A steroid injection may give you some short term relief, particularly if your pain is severe. There are pros and cons with injections so it’s important to discuss it with your physiotherapist or GP. Here at Roundwood Health Clinic, we are able to offer steroid injections under ultrasound guidance which ensures a great accuracy of needle placement. It is still important after a steroid injection to continue with the stretches and advice.
If after 6-12 months of your symptoms failing to improve your physiotherapist may ask your GP to consider referring you to see a consultant. Surgery is an option for plantar fasciitis but should always be considered as a last resort when all other conservative treatments have failed.
Prevention of plantar fasciitis
Making a few lifestyle changes can reduce your risk of developing plantar fasciitis (particularly if you are a runner):
• Make sure you wear good-quality trainers that have good cushioning or shock absorption.
• Get advice on the best shoes for you – plenty of running shops now offer this service
• Replace your trainers as soon as they become worn out. Around 400 to 500 miles is the limit for each pair of shoes before you should buy new ones.
• Avoid exercising on a hard surface and incorporate low impact exercises into your routine such as cycling.
• Make sure you regularly stretch, both before and after exercise and build strength in your leg muscles.
• Maintain a healthy weight.
If you or any other person has a medical concern, you should consult with your GP or physiotherapist or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking it because of something that you have read on this blog or in any linked materials.
Physiotherapy, Orthotic assessments and Ultrasound-guided steroid injections can all be booked online via the website or call us on (01226) 282560.