Are your initial steps in the morning painful? Are you limited by an ache or sharp pain underneath your heel when merely standing, walking or running? It could very well be that you have plantar fasciitis and it will only get worse over time if you don’t act now.There isn’t a day that goes by where we do not rely on our feet, which is why you should take heel pain seriously.
The most common cause of rear foot or heel pain is plantar fasciitis. This condition can affect all ages, but mainly occurs in athletes and the average adult. Plantar fasciitis is usually of insidious onset.
How does plantar fasciitis come to be?
The plantar fascia is a layer of connective tissue that runs from the calcaneus (heel bone) to the proximal phalanges of the toes. As increased load and stress is applied to the tissue it may become irritated and reactive over time. Risk factors can include:
- A high BMI (body mass index)
- Improper alignment of the foot
- Non-supportive footwear
- Gait abnormalities
- A training volume issue, especially in athletes and runners
- Standing based work, especially on hard surfaces
- Poor flexibility and strength will mean that the tissue is not capable of handling loads or that it can even alter foot biomechanics/alignment
How physiotherapy will help!
Physiotherapy will aid in minimising your symptoms and flare-ups through several modalities. Based on your goals, treatment will primarily include:
- Education and advice regarding plantar fasciitis and how you can specifically fix it. Advice will also revolve around load management with athletes or to potentially reduce standing hours for others
- A foot assessment to determine if you require contoured foot orthoses and/or a change in footwear
- Application of tape to support the plantar fascia and give you symptomatic relief
- A graded strengthening program of the calf and FHL (toe muscles) and other muscle groups, if required
- Soft tissue therapy of the plantar fascia and/or proximal myofascial regions
- Neural assessment and related treatment if appropriate
- And more…
Some tips that may help at home:
- Roll a golf ball or frozen bottle underneath the foot to self massage and reduce tissue tone
- Stretching the plantar fascia first thing in the mornings by either placing your toe on the wall and heel on the floor, or using your hands to pull your ankle and toes towards yourself
- Avoid dress shoes. If they are required for work then use either a heel cup or silicone gel heel pad
Alternatively, It may be that your heel pain is not plantar fasciitis as there are several other clinical presentations that may manifest similar symptoms. Such presentations can include but are not limited to:
- Tarsal tunnel syndrome
- Bursa irritation syndromes (retrocalcaneal or calcaneal)
- Calcaneal stress fracture
- Posterior ankle impingement
- Achilles tendonitis
- Severs disease (in adolescents)
- Nerve entrapment or referred lumbar spine pain
Hence, it is crucial to take heel pain seriously and have it assessed and managed appropriately by a professional.
Veeral is a physiotherapist who works in our Blacktown clinic. He has an interest in sports and musculoskeletal physiotherapy and management of orthopaedic and spinal surgical patients.