Foot & Heal Pain
Plantar Fasciitis: A common cause for Heel Pain
If you have are experiencing pain under the foot or even at the heel, chances are you may be suffering from plantar fasciitis.
Who can you look to for help?
Both the Physiotherapist and Podiatrist are highly trained in managing plantar fasciitis and heel pain. However, in majority of the causes, guidance from both a physiotherapist and podiatrist is the most efficient team approach to treatment.
What is Plantar fasciitis?
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of the plantar fascia which thick band of tissue that runs across the bottom of your foot, starting at the heel all the way to the toes.
Pain from Plantar fasciitis is commonly described as a stabbing pain that would normally occur with your first steps in the morning. However, as you get up and start walking around the house, the pain will start to decreases. You may also experience symptoms with long periods of standing or when you stand up after sitting. Even though it is a very common condition in the general population it tends to be more prevalent in runners and in people who are overweight.
What are the Symptoms of Plantar Fasciitis and Heel Pain?
The most common symptom of Plantar fasciitis is typically described as a stabbing pain in the bottom of your foot near the heel.
The pain from plantar fasciitis usually develops gradually over time and can be felt as dull or sharp with specific activities.
A characteristic of plantar fasciitis heel pain is that you may not feel pain during activity but rather just after finishing. Such pain flare ups are a sign of underlying inflammation.
Heel pain is usually the worst with the first few steps after awakening and can also be triggered by long periods of standing or when you get up from sitting.
What Causes Plantar Fasciitis and Heel Pain?
The plantar fascia is a band of tissue (fascia) that connects your heel bone to the base of your toes. It supports the arch of the foot and absorbs shock when walking. Plantar fasciitis and heel pain tends to develop as a result of overstretching or overuse of this fascia, which can lead to small tears along the tissue. The most common site of pain being felt at the heel at the insertion of the plantar fascia.
Heel pain from plantar fasciitis is one of the most common injuries across the general population. Active men and women between the ages of 40 and 70 are usually at the highest risk for developing heel pain from plantar fasciitis and is slightly more common in women than men.
What Contributes to Plantar Fasciitis and Heel Pain?
There are various contributing factors that can lead to acute or overuse injuries in the plantar fascia, leading to heel pain:
Your Footwear:
In our clinics we commonly come across people with plantar fasciitis who have been using inappropriate footwear. They tend to have shoes that may be too flat, flexible, and have poor arch support. This lack of support is stressful on the plantar fascia and the heel and may result in overstretching of the tissue. Prolonged use of such footwear, especially during walking running or even exercising will lead to plantar fasciitis or other types of heel pain. Therefore, in such circumstances, it is essential that you see a podiatrist to have your shoes assessed. This will help to treat plantar fasciitis by minimizing the physical stress on its insertion at the heel.
High Foot Arches:
People with high arches of the foot will generally receive less support from shoes and their inner arch support as there will be less contact through the sole of the foot to the arch of the shoe. The tightness of the plantar fascia due to high arches and a lack of support from the shoes can lead to heel pain and plantar fasciitis due to overstretching.
Flat Feet:
The flat foot also know as pes planus is often caused by weak ligaments and you may notice the inside of your foot flattens and can sometimes touch the ground when you stand. The plantar fascia therefore works harder and has more stretch placed on it, along with other muscles and tendons, to compensate for this weakness. The increased load can lead to plantar fasciitis or heel pain. If the increased load is sufficient to cause overstretching, the tissue can tear and cause inflammation.
Body Weight:
Some of the patients we see with heel pain in our clinic have a higher-than-normal BMI and therefore are carrying more body. This increases the load on their feet and hence more strain on the heel and plantar fascia. With time and with increased activities like walking, they may start to experience pain following tears and inflammation in their plantar fascia.
How is Plantar Fasciitis Diagnosed?
Our physiotherapist and podiatrist are trained and experienced in accurately diagnosing plantar fasciitis. Through a detailed physical assessment your medical history and your level of activity, they are able to diagnose the causes of your heel pain. During the assessment, your health care provider will check for areas of tenderness in your foot as the location of your pain can help determine its cause. Usually, no additional scans are required but an X-ray or an ultrasound may be suggested to rule other underlying problems such as a stress fracture.
Treatment for Plantar Fasciitis and Heel Pain
Majority of the patients with plantar fasciitis will recover well through conservative treatment undertaken by physiotherapists and podiatrists. Primary aim of the treatment is to minimize pain, modify footwear and activities to reduce the stress on the heel and to implement strategies that prevent future recurrence.
In Clinic Pain Treatment:
Walking Boot/CAM Boots are commonly prescribed to minimize the load on the heel and the plantar facia. Depending on the severity of the symptoms and the level of pain, your physiotherapist or podiatrist may prescribe a boot for 2-3 weeks. The protective boot will allow you to walk and go through your daily activities with minimal to no pain in the heel. In addition to the boot, common pain treatments include Shockwave Therapy, Exercise Therapy and Dry Needling.
Extracorporeal shockwave therapy (ESWT) has been an effective treatment option for pain management and injured tissue stimulation for many decades. During shockwave therapy ultrasound waves are directed to the localized area of heel pain. These shockwaves have been shown to stimulate healing in the torn and injured fascia in addition to reducing the pain. Physiotherapists and Podiatrists require specialized training to use shockwave therapy and our team in Richmond is fully trained and have been successfully treating this condition for the past decade.
Our physiotherapists will prescribe a combination of strengthening and stretching exercises to help relieve tension and stress through the plantar fascia. Exercise therapy is also used as a key tool to prevent long term recurrence of plantar fasciitis.
Dry needling involves administering fine acupuncture needles into a soft tissue structure with the aim to reduce pain and improve joint range of motion by helping a tight muscle to ease tension. In case of plantar fasciitis, tight calf muscles have shown to increase the stress over the fascia and contributing to the symptoms. Our physiotherapists are trained in treatment with dry needling and when done for tight calf muscles, it can help relieve pressure over the heel.
Podiatrists are best suited to guide you on foot orthotics and your footwear. Depending on the severity of symptoms and the level of contribution from your foot type, the podiatrist could prescribe off-the-shelf or custom-fitted arch supports (orthotics) to distribute the pressure on your feet more evenly.
In case other therapies fail to show progress, injecting steroid medication into the tender area can provide temporary pain relief. Corticosteroid and PRP injections are commonly used by sports physicians to help with pain reduction. However, these injections are not 100% effective, and some patients may not have pain relief.
In rare cases, some people need surgery to detach the plantar fascia from the heel bone. Surgery is only an option when all other types of treatments have failed, and the pain is severe enough to debilitate an individual.
Heel Pain Home Treatments
While our clinic in Richmond offers same day appointments, there may be times where we are unable to accommodate you on the same day. Therefore, while you wait to see a physiotherapist or podiatrist, there are some home-based remedies that can be done to help manage the symptoms.
Home Based Exercises: Download
Reduce Weight Bearing:
Initial home treatment includes staying off your feet and attempting to reduce weight bearing through the painful heel.
Ice Application:
Regularly apply ice for 15 to 20 minutes, 3 or 4 times per day till your appointment.
Medication:
Over the counter Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen may soothe pain till you see the physiotherapist or podiatrist.
For accurate assessment and treatment of heel pain, see one of our clinicians today!