Heel Pain and Plantar Fasciitis

There are many possible causes of heel pain, but plantar fasciitis (pronounced fa-shee-ai-tuhs, meaning inflammation of the plantar fascia) is a particularly common one that we see at City Osteopaths. The pain of plantar fasciitis is usually felt on the underneath or inside of the heel, in contrast to Achilles tendonitis, which is more commonly felt on the back of the heel. The pain is typically worse when walking, particularly first thing in the morning or after a period of sitting. Usually, the pain is easier when wearing supportive shoes compared to being barefoot.

The plantar fascia is a ligament like structure that supports the arch of the foot by tethering the two ends together – attached to the heel at one end and the base of the toes at the other. Pain occurs when the plantar fascia’s attachment at the heel becomes strained. This can be caused by various factors, including: a change in footwear, or an increase in time spent barefoot, an increase in exercise intensity, prolonged periods of standing, increased time spent walking on hard surfaces, and especially a gain in weight. Having tight calf muscles, stiff ankle joints or increased pronation (which typically features fallen arches in the feet) can also predispose to plantar fasciitis. All these factors increase the pressure on the plantar fascia to support the arch of the foot. If this pressure becomes too great, strain can occur leading to pain.

A diagnosis of plantar fasciitis can be made based on a description of the symptoms and an examination of the foot. Imaging such as x-rays or MRIs are not normally needed. Occasionally, patients who have received an x-ray, may have been told they have a calcaneal spur. This is a small bony growth on the heel, which can be present in people without heel pain or plantar fasciitis, so is often a misleading finding. However, it may be a sign of long-term strain on the plantar fascia with the bone growth a result of the body trying to repair itself.

Plantar fasciitis often resolves on its own, particularly if the cause can be identified and addressed. However, this can take months or even longer, leaving the sufferer unable to walk and exercise normally. There are various treatments for plantar fasciitis, none of which are significantly more effective than the other. However, a combined approach using, exercise, manual therapy, activity modification, and orthotics where indicated, is probably the least painful, most low risk, and cheapest available, and consequently the one adopted here at City Osteopaths. The various treatments available are as follows:

Physical therapy – strengthening exercises for the foot and ankle have been shown to be the most effective, but some stretches can also help with the pain. Soft tissue and joint mobilisation treatments have also been shown to be beneficial, particularly if the sufferer has stiff ankles and calf muscles. Sometimes, splints are prescribed to be worn at night to help stretch particularly stiff ankles.

Orthotics – these are insoles that are worn in the shoes. They can offer additional support to the arch of the foot to reduce the strain on the plantar fascia. They can also help to correct problems associated with pronation. Custom orthotics can be expensive and are often uncomfortable and generally unnecessary. Cheaper, soft, standard fit orthotics have been shown to be just as effective and are the preferred choice here at City Osteopaths if indicated.

Cortisone (steroid) injection – these can be effective in the short term, but often the symptoms return. The injections can be very painful and there is a risk that the steroid can damage the fat pad in the heel, which can cause further issues.

Extracorporeal shock wave therapy – this treatment was originally developed to treat kidney stones. As calcaneal spurs are like kidney stones, the treatment has been used for plantar fasciitis. However, not all plantar fasciitis features calcaneal spurs, and the spur is not always the cause of the pain. This may explain why the results of shock wave therapy are very mixed. There are few risks associated with the treatment, but it can be very painful.

Advice – individualised advice can often be the most useful treatment. Sometimes simple changes, like putting shoes on in a morning before standing, can make a big difference when coupled with the right exercises.

If you would like help with plantar fasciitis, please contact the clinic or share this post with someone you know who may be suffering.