Heel pain? Plantar Fasciitis? Can you imagine every step that you walk causing a stabbing pain right into your heel? Do you wake up in the morning walking like an old lady or man for the first 15 minutes of getting out of bed?
Plantar Fasciitis is a common problem within society. We have briefly touched on this topic previously here as this is something Podiatrists deal with very often.
With limited data available it is estimated that 10% of people in society will suffer from this at one stage of their life and possibly account for about 8% of all running related injuries.
There is also some new research you can read here.
Let’s explore a few things about this painful injury:
– What the Plantar Fascia is?
– What are the risk factors for Plantar Fasciitis?
– Symptoms of Plantar Fasciitis.
– Why does it present like this?
– How we can treat it?
What is the Plantar Fascia?
The Plantar Fascia, is a tight band of very thick and fibrous fascia. It runs from the heel bone to the toe bones within the foot. It has three bands that are very important in helping form the integrity of the arch.
This structure is not alone in helping maintain the integrity of the arch in the foot. However, due to the thick fibrous nature of the fascia compared to a muscle and tendon which tends to have more stretch, the focus is put into the fascia!
Heel Spurs are also synonymous with Plantar Fasciitis. It is unknown how much of a role that heel spurs plays with this condition. However my mind is cast back to University and being introduced to Wolff’s Law.
Wolff’s Law is one that states that bone will adapt to the load that it is put under. Hence, if the Plantar Fascia is connected to the heel bone, and if that Fascia is tight, it will pull on the heel bone.
According to the American Association of Orthopaedic Surgeons (AAOS), 1 in 10 people have a heel spur, but only 1 in 20 people with heel spurs experiences pain.
Now we have seen this tight structure has a direct impact to the bone that it is attached too. It would make sense that the Plantar Fascia also plays an important role in those muscles further up the leg.
Tight calf, hamstring and glute muscles are not uncommon with people who have this heel pain.
What are the risk factors of Plantar Fasciitis
So why do so many people have heel pain and others don’t? We know that middle aged obese ladies and the younger male athletic population will have the largest incidence of heel pain.
Today’s society and lifestyle will play an important role in risk factors for this painful injury. Lets have a look at some of the risk factors for the general population:
- Footwear – Poorly fitting shoes or footwear with little integrity. Many shoe brands in today’s society will market ‘Memory Foam’ or some other magical foam of soft cushioning that a shoe is made of. It may feel soft to start off with, however little support within a shoe generally doesn’t end well.
- Excess body weight – 1.5-1.75 x our body weight going through our heel bone when we walk. Example an 80kg person will have at least 120 – 140kg of body weight going through our heels!! (//nccih.nih.gov/research/results/spotlight/Plantar-Fasciitis-Pain)
- Poor foot posture – High arch and low arched feet will place excessive loads through this structure.
- Job – Occupations that require you to be on your feet a lot. Think a store person working in a factory or a checkout person doing groceries at Woolworths.
- Muscle Function – Tight muscles in the lower leg, specifically the Achilles Tendon.
Symptoms of Plantar Fasciitis
We now know what the Plantar Fascia is and importantly what risk factors will increase our chance of this. Let’s have a look over the symptoms now.
They will gradually increase over time, and become worse. I have had many a patient reduced to tears from the pain of activities of daily living!! Let’s have a look at some of the more classical symptoms that people will start to feel.
- Pain in the morning on rising – Usually a sharp stabbing pain in the heel, sometimes it will start as a dull ache. The first few steps of a morning will be very painful. Typically then as the structure gets warmed up the pain will be relieved.
- Prolonged periods of stand or sitting then become active or mobile again for the first few steps of weight bearing.
- Pain after exercise, usually not during.
- Swelling and inflammation in the heel bone.
- As the problem becomes chronic (think long term) this pain won’t dissipate after a 10-15 minutes and will hang around for longer periods of time.
Why does it present like this?
The fascia as we know is very thick and fibrous fascia. Unfortunately this fascia doesn’t have much stretch, so when we spend time off our feet it contracts.
Obviously when it contracts and gets in this position after a possible 8-10 hours of sleep and suddenly it has to bear our body weight.
With this force that goes through this structure it will start to get micro tears.
This area of the body is unfortunately avascular, which means it doesn’t get a great deal of blood flow, which can lead to the painful cycle that leads to the worsening symptoms above!
How can we treat it?
As we can see above there are many risk factors with this structure if the body. We can obviously treat this injury many ways.
Choosing the best way due to those varying risk factors, foot types, and daily activities of life is usually best left to a professional!
However there are a few things that a Podiatrist will make sure that you start treatment with…
- Icing the foot – In the initial stages this is a good way to get some acute relief.
- Stretching – We know we have tight muscles, targeted stretching depending on where your tight spot is a must.
- Strapping – This is a nice effective way of being able to support the foot when it doesn’t have footwear on.
- Footwear – Most people won’t know when their shoe has reached it’s end of life. Some other people will be wearing footwear that is’t very supportive contrary to a brand’s marketing.
- Orthotics – If your foot type is flat, orthotics can be a good long term option. You can read more about them here…
These are some of the conservative methods to get rid of this nasty heel pain. If the problem is chronic and conservative treatment hasn’t helped you, there are other options.
If you have heel pain and want a second opinion, please come and see one of our friendly Podiatrists.
- Healthline. (2019). Everything You Need to Know about Plantar Fasciitis. [online] Available at: //www.healthline.com/health/plantar-fasciitis#causes [Accessed 7 Aug. 2019].