Heal my heel pain
Every day I have patients coming into the clinic telling me they have plantar fasciitis, diagnosed by Doctor Google. Although in many cases this diagnosis may be correct, the exercises prescribed by many internet sites may actually be a hindrance towards recovery.
Plantar fasciitis is a very common condition, largely seen in middle-aged obese woman, young male athletes, in people with standing occupations and those with poor foot and leg bio-mechanics. 1-2 Obesity is seen in 70% of plantar fasciitis cases. 3 It is estimated that 10% of people will develop plantar fasciitis in their lifetime. 4 There are several people that seem to feel that their symptoms will never go away and that it is something they will have to put up with for the rest of their lives. If there is one thing you take away with you from this article, it is that just like any other injury; with proper management PF can improve greatly and often be fixed entirely.
I have had many patients limp into the clinic barely being able to walk and through the correct conservative management; we have been able to nurse them back to full health to allow them to return to work, running, sports etc.
So what is it?
The plantar fascia originates at the heel and attaches to the base of the toes with its purpose to maintain the integrity of the arch. With every step that we take, our foot flattens, some more than others, which places a stretch on the plantar fascia. Through repetitive trauma, the fascia becomes overworked and pain may result, usually at the attachment site on the heel. Due to this injury being under our foot, and we are all busy people that need to work, pick up kids, exercise etc, we do not allow this injury to heal.1
What are Heel spurs?
50% of plantar fasciitis patients have heel spurs; it important to know this generally does not cause plantar fasciitis or increase symptoms. Heel spurs are the body’s plan B to trying to heal the injury. The body firstly tries to thicken up the plantar fascia to give it reinforcements, once this fails the body decides to form bone at the attachment site.5
What else could the heel pain be?
Differential diagnosis for heel pain:6
|Achilles tendinitis||Arthritis/instability of mid foot||Entrapment of Baxter nerve|
|Fat pad atrophy||Bone contusion||Medial calcaneal nerve injury|
|Plantar fascia rupture||Spring ligament injury||Peripheral neuropathy|
|Plantar fibromatosis||Calcaneal stress fracture||Tarsal tunnel syndrome|
|Posterior tibial tendinitis||Charcot/neuropathic arthropathy|
When treating plantar fasciitis, it is important to address not only the symptoms, but the underlying cause; therefore, the treatment protocol will differ from person to person. Treatment involves a series of steps. Through assessment, your podiatrist will determine when a step has been fulfilled and progression to the next step is appropriate. Initially, in most cases, it is important to reduce tension within the calf muscles and plantar fascia, as well as calm down the symptoms. Further steps may involve the use of manual therapies and strengthening. 80% of patients with plantar fasciitis resolve within a year with conservative treatments.7
If you are suffering heel pain, don’t waste time with Doctor Google. Come in to Stay Tuned Sports Medicine for podiatry management and a tailored plan to help get you back doing the things you love. The earlier you seek profession treatment, the greater the chance of healing.
1. Tahririan MA, Motififard M, TahmasebiMN, Siavashi B. (2012). Plantar fasciitis. Journal of Research in Medical Sciences 2012;18(8):799-804.
2. Healey K, Chen K. (2010). Plantar Faciitis: Current Diagnostic Modalities and Treatments. Clinics in Podiatric Medicine and Surgery 2010; 27(3):369-380.
3. Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport 2006; 9:11-22.
4. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am 2003; 85:872-7.
5. Wainwright AM, Kelly AJ, Winson G. Calcaneal spurs and plantar fasciitis. Foot 1995; 5:123–126.
6. Fink, B. R. Management of Plantar Fasciitis Evolving. The Journal of Musculoskeletal Medicine 2012; 29(1):16-20.
7. Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int 1998; 19:803-11.