Heel Pain / Plantar Fasciitis

Plantar Fasciitis

Introduction
Plantar Fasciitis is a common cause of heel pain. The plantar Fascia Sheath is made up of connective tissue it becomes painful, inflamed and degenerative at its attachment to the calcaneus bone or along one of its three bands that span the longitudinal arch of the foot. Chronic forms can develop a heel spur €“ 70% of plantar fasciitis sufferers have been noted to have this

Etiology
The Plantar Fascia acts as a shock absorbing bowstring which supports the longitudinal arch of your foot. It transfers the weight from your rear foot to your fore foot during gait. It is consistently getting stretched when your foot is weight bearing and relaxed when your foot is Non Weight Bearing. If this stretch increases or becomes too much it can create micro tears in the fascia. With repetition this can create pain and inflammation. Over a long period of time a degenerative process is witnessed.

Overpronation or Pes planus foot type €“ causing the Fascia to stretch more when placed in a NWB position
High Arch feet that drop due to ageing process, medication or trauma €“ causing increased stretch to the fascia
Obesity €“ can put extra stress through the Fascia
Middle Age Woman>Men are more prevalent
Occupations where standing/walking long periods especially on hard surfaces €“ waitresses, construction workers, hairdressers, factory workers
Improper footwear €“ Shoes that are hard or thin soled, unsupportive or loose. Continual wear of high heeled shoes can cause the Achilles Tendon to tighten which increases the strain to your heel and Plantar Fascia

Symptoms
Pain develops gradually €“ getting worse over weeks/months
One or both feet can be affected
Pain at medial aspect of heel, along the longitudinal arch and occasionally at the fascia€™s attachment to the metatarsal heads
Pain worse on first steps or after periods of rest, pain will decreases as foot/fascia warms up
Pain then increases as day goes on or if exercise is increased
Pain on palpation of the medial aspect of the calcaneus or along the fascial tendons

How a Podiatrist can help?
Diagnosing and treating any occurring foot deformities with orthoses devices €“ Thus reducing the stretch/strain on the longitudinal arch and fascial tendon
Stretching Regime of Achilles and Plantar Fascial Tendons
Footwear advice
Advising activity modification and ice management
In severe cases a Night Splint can keep the heel stretched during the night €“ so it does not become contracted
Non Steroidal Anti-inflammatory drugs can help minimise pain and inflammation