Heel pain (Plantar Fasciitis) – Causes, Prevention, Symptoms, Treatment
What is Plantar Fasciitis?
As podiatrists, we commonly see patients suffering from heel pain. Heel pain can be an indicator of many different conditions including the following; plantar fasciitis, Achilles tendinopathy, bursitis and heel spurs. The most common cause of heel pain is plantar fasciitis. Although it was previously thought to be an inflammatory condition, research has recently declared it a degenerative condition, due to micro-tears in the plantar fascia. The Plantar fascia is a band that supports the arch of the foot, it connects from your heel to the base of your toes. The condition is usually caused by multiple factors, however often biomechanical imbalances are involved. These biomechanical imbalances result in repetitive strain of the structure and thus micro-tearing. Often plantar fasciitis and heel spurs are associated with one another. A heel spur may develop on the heel bone as a direct result of constant pulling at the attachment site of the plantar fascia. A heel spur can be either on the bottom of the heel or at the back of the heel. Heel spurs develop over time and are often asymptomatic, however, they have been known to cause pain in some people.
What causes Plantar Fasciitis?
There is not usually one single cause of plantar fasciitis, but likely an array of contributing factors. These may include;
- Biomechanical imbalances (related to the way the body moves)
- Tightness in the calf muscles – Altering biomechanics
- Sudden weight gain – This places a greater load on the soft tissues in the feet
- Poor footwear – non supportive/ill fitting shoes or shoes that are worn out
- Standing for long periods of time on hard surfaces
- Sudden increase in exercise load and intensity
Although anyone can suffer from plantar fasciitis, research has shown us that it is most common in the following demographics;
- Middle-aged people
- Long distance runners
- Obese people
- Military patients
How can you prevent Plantar Fasciitis?
There are many methods in which you can prevent plantar fasciitis. These include;
Orthotics – As we are aware, biomechanics can play a role in the development of plantar fasciitis. Have your podiatrist assess your foot posture and your walking/running gait to determine whether custom orthotics could prevent you from suffering with plantar fasciitis.
Suitable footwear – Ensure that your footwear is supportive and well fitted to your foot type. It’s always best to have your footwear professionally fitted. Ensure that your footwear is replaced regularly, once your shoes are worn out they cannot support your foot efficiently.
Keeping active and eating a balanced diet – Physical activity and a healthy diet have an array of health benefits, including moderating our body weight. As we know, being overweight or gaining weight rapidly can contribute to the load placed on the plantar fascia and therefore result in inflammation.
Strengthening of the calves – Research has proven that weakness in the calves can contribute to the development of plantar fasciitis. Calf specific strengthening such as; double leg calf raises and single leg calf raises with a slow descent (eccentric phase) can help to prevent heel pain.
Warm up and cool down when exercising – An adequate warm up/cool down can encourage blood flow to the muscles of the body. Ensure to include plenty of slow calf stretches, ankle circles, specific plantar fascial stretching and some dynamic movements to prepare the body for exercise.
What are the signs and symptoms of plantar fasciitis?
If you have plantar fasciitis you will most likely experience the following symptoms;
- Pain in heel of foot (usually the inside of the heel)
- Heel pain when weight bearing
- Heel pain in the morning – Usually the first few steps after getting out of bed
- Heel pain which improves with rest
- Heel pain that gradually gets worse over time
- Tightness and pain in the arch of the foot
How is it diagnosed?
In order to diagnose plantar fasciitis, your Podiatrist will take a thorough history of your heel pain. Your Podiatrist will gather as much information as possible in regard to your heel pain to ensure an accurate diagnosis. Your Podiatrist will also conduct various physical examinations and tests to determine whether your heel pain is specific to that of plantar fasciitis, this may include joint and muscle testing.
Often imaging (in this case, ultrasound) will be used to diagnose plantar fasciitis.
Can Plantar Fasciitis go away on its own?
Yes, on the rare occasion plantar fasciitis can go away on it’s own, however, research has revealed that the following treatments may encourage a reduction in pain/resolve the condition more rapidly;
- Anti-inflammatory medication
- Focused plantar fascia stretching as well as the calves – Research has proven that tightness in the calves can restrict ankle range of motion and thus contribute to heel pain.
- Specific plantar fascia strapping – taping to support the arch and temporarily change the posture of the foot to offload the affected structures.
- Activity modification – Exercise will place an extra load on the plantar fascia, so often it is necessary to rest from walking/running to allow the structures to heal.
- Footwear modifications – Your Podiatrist may make footwear recommendations that will assist in your heel pain.
- Shockwave therapy – Shockwave therapy is used to stimulate the healing response and has been recognised as a successful treatment method for heel pain and other lower limb pathologies.
- Dry needling – targeted at tight muscle fibres, dry needling can release tension and assist in relieving pain associated with plantar fasciitis.
- Massage and icing – Both massaging and icing the affected area can assist in relieving symptoms.
- Orthotics – Orthotics will help redistribute the plantar pressures, allowing the plantar fascia to recover.
When is surgery needed?
As with any surgery there are many risks associated, however, if conservative treatments fail after 6-12 months and pain persists surgery may be considered.
It is important to note that in every case of plantar fasciitis there is usually an underlying cause. If this cause is not identified and addressed it is likely that the plantar fasciitis will reoccur. In some cases the underlying cause may not be modifiable, this is where preventative strategies become paramount to keeping the heel pain at bay.
In other cases the underlying cause may be relevant to your biomechanics or your foot posture. If this is the case, your Podiatrist may prescribe a pair of custom orthotics. As previously mentioned, orthotics will redistribute the plantar pressures and potentially correct your foot posture, addressing any biomechanical contributors to your heel pain.
Your Podiatrist may also prescribe a stretching and strengthening program to address any weaknesses and tightness in your muscles. We know that restricted ankle joints and weakness in the calf muscles are great contributors to heel pain. A stretch and strength program is a long term strategy to keep your heel pain at bay.
Heel pain in children
Children can also experience heel pain, however, the most common cause for heel pain in children aged under 16 is Sever’s Disease (or calcaneal apophysitis). Sever’s disease is inflammation of the growth plate in the heel and is most common among active children. When a child is growing, all the structures tend to grow at different rates which can cause pulling on the growth plate. This pulling then leads to inflammation.
Symptoms of Sever’s Disease include;
- Pain and swelling of the heel
- Tightness in first steps in the morning
- Pain when the heel is squeezed
- Limping or tip toeing
What contributes to the development of Sever’s Disease?
While Sever’s Diseases is caused by the varying growth rates of bones, muscles and tendons, there are many other factors that can contribute to the condition. These include; The child’s height and body weight, the type, intensity, frequency and duration of exercise that the child is doing, the surface on which the child is exercising, the choice of footwear and the foot posture/biomechanics of the child.
How is Sever’s Disease treated?
Your Podiatrist may suggest the following treatment methods;
- Activity modification/rest – Your child may be advised to reduce certain activity that places load on the heel. In some cases, it may be advised to rest from sport for a week or two to encourage a reduction in pain and recovery of the associated structures.
- Use of heel raising device – Heel raises are often placed in the shoe to decrease the load on the tendon. The can only be a temporary solution, as they encourage shortening of the achilles tendon.
- Strapping – Sports strapping can be used to support the affected structures, giving them a chance to heal.
- Orthotics – Your Podiatrist may provide orthotic options for your child. The orthotic is designed to redistribute the plantar pressures and therefore reduce the load going through the heel.
- Icing to reduce inflammation – Icing the area when painful can help to reduce inflammation and pain.
If your child is experiencing heel pain, it is always best to visit your Podiatrist as soon as possible for assessment and treatment.
Want to see someone?
At Foot Centre Group we believe that each and every patient is different and will respond differently to treatments. We highly value our patients’ time, so we ensure our consultations are precise and efficient. Your podiatrist will take a thorough history of your pain, as well as assess you biomechanically to diagnose your condition. We assess each and every case individually and decide upon a treatment plan that is specific to our patients needs.
If you are suffering heel pain, we would love to be a part of your journey to allow you to get back to the activities you love.
Call 03 9553 0044 or make an appointment HERE for your assessment with one of our team!