Plantar Heel Pain
Plantar Heel pain also known as Plantar Fasciitis is a common foot condition. At least 10% of the population will have, at least some stage in their life time.
Pain is typically located at the point the plantar fascial tendon inserts into the calcaneus or heel bone. This fascia run down the foot attaching into the toes and helps form our medial longitudinal arch. It helps provide static support and dynamic shock absorption of the arch.
In the x-ray on the left you can see bony spurring at the point of pain.
While heel spurs are common on x-ray, they are typically not related to the pain. In fact many people have spurs and have no heel pain.
Symptoms of Plantar Heel pain include:-
1. Pain on first movement, particularly in the morning or after rest.
2. Painful on palpation.
3. The pain can sometimes decrease during activity, but be aggravated by standing.
Research suggests plantar heel pain involves degenerative changes to the collagen of the tendon.
Causation is believed to be related to overload of the tissues. This may involve too much standing, walking or running. It is associated with being over weight. It also occurs in long distance runners.
Treatment involves accurate diagnosis of the condition as other conditions can cause heel pain including bruising of the fatty pad, stress fracture of the calcaneus and nerve impingements.
Gold standard investigation is ultrasound which may show swelling of the plantar fascia insertion into the heel bone.
Treatment is individualised depending on your foot function. But may include:-
1. Increasing ankle joint range of motion.
2. Reducing excessive movements of the foot.
3. Increasing the foot's ability to absorb shock.
4. Foot strengthening exercises.
5. Footwear changes.
6. Foot orthotics may be prescribed.
Positive Podiatry can provide a wide range of customised and custom made foot orthotics. This depends on your individual requirements.
Steroid injection into the fascia should be used with care. The negative side effects of steroid injections can be plantar fascia rupture and breakdown of the fatty pad.
Shock wave therapy is only necessary in chronic cases over 6 months.
Individualised advice is essential for rapid resolution.