Plantar Heel Pain

So what causes Plantar heel pain / Plantar fasciitis



Unfortunately a change in activity level can lead to soft tissue injury and pain. This often occurs when there is increased stress applied to the tissue in question. If the tissue is not capable of tolerating that stress damage and pain can occur. 
The concept of tissue stress is commonly used in the treatment of musculoskeletal problems but this is a subject that requires its own post that will be added in the coming days. But the important thing to know is that all tissues have an amount of stress that they can tolerate before they can become damaged. 
The best way to increase a tissue's tolerance to stress is to apply stress or load in a controlled manner to enable it to adapt and become stronger to allow it to tolerate more. 
A common issue that can occur when there is too high a load/stress applied is plantar heel pain or as it is commonly known Plantar fasciitis. 


It had previously been thought that Plantar Fasciitis involved chronic inflammation however more recent studies have concluded this is not the case. We will  often refer to it as Plantar Heel pain as that is a more accurate description as the ’itis’ refers to Inflammation of the plantar fascia which is not now thought to be present. 


So what is the plantar fascia

The plantar fascia is a thick band of connective tissue that supports the arch of the foot. It runs from the heel bone (calcaneus) where it fans out to the toes. 

Plantar Heel pain

The plantar fascia contributes to support of the arch acting like a tie-rod when it undergoes tension as weight is applied to the foot. One of its main functions is to make the foot rigid during ‘push off’ through a mechanism known as the windlass mechanism which occurs when the big toe flexes up. 


Presentation


Typically a classical sign of ‘Plantar fasciitis’ or plantar heel pain are as follows
  • Gradual onset of pain
  • History of increase in activity
  • Pain on touch on sole of the foot at the heel
  • Pain in the morning or after periods of rest
It is also thought that the biggest contributor to disability is related to pain related fear of movement. 

Treatment


There are a number of proposed treatments for plantar heel pain and not one treatment is seen as most beneficial in the medical literature. The most common treatment approaches will generally involve
  • Footwear advice
  • Weight loss
  • Stretching
  • Night-splints
  • Low/High Dye taping
  • Intrinsic Muscle strengthening
  • Orthotics both off the shelf and custom
  • NSAIDS - limited to early stages
  • Extracorporeal Shock Wave Therapy
  • Surgery

Footwear Advice

Large amounts of standing and walking on hard surfaces have been shown to be a risk factor and it has been found that shoe rotation during the working week can reduce the risk of plantar heel pain
It is also though supportive shoes with a cushioned heel are helpful in the initial treatment. 
It has also been suggested that the addition or use of shoes with a rocker sole may be of help to reduce pain while walking. 

Weight Loss

Weight Loss can be helpful as the less a person weighs the less force is trying to flatten the arch thereby decreasing stress through the plantar fascia. 

Stretching

Tightness in the calf muscles will lead to a decrease in available motion at the ankle joint that can lead to an increase in tension in the plantar fascia. 
Stretching of the Calf muscles both gastrocnemius and soleus has been shown to be effective. 
Calf (gastrocnemius) Stretch on bottom Stair



Calf (soleus) Stretch with knee bent

Some studies have also shown that the outcome can be better when stretching is done in combination with orthotic (insole) therapy. 
It has also been found that hamstring tightness can be a risk factor. One study reported that people with hamstring tightness were 8.7 times more likely to develop plantar fasciits!

Night Splints

The aim of a night splint is to provide a low level stretch to the Calf muscles and plantar fascia. It is however unclear from the evidence if they are effective.
Night Splint to stretch Calf and flex toes

Foot Orthoses / insoles

The literature is conflicted with regards to the use of foot orthoses in the treatment of plantar heel pain. The main area of conflict is the use of standard/off the shelf insoles over custom insoles. Often the issues with such studies is that they are applying one treatment to a large group of people with heel pain.  Due to the diverse nature of the problem this is not a sensible approach. At the Buchanan Clinic we believe in treating each person as an individual not as a population or statistic.   

Unfortunately this means there is not one magic orthoses or insole to cure heel pain

Sense Heel Pain Insoles

Taping

It has been shown that applying taping to the foot can help reduce symptoms of plantar fasciitis or heel pain. Often this is a good first line of treatment and can help reduce the pain and discomfort. 
Our Orthotist Graham will regularly use taping techniques on himself as he is prone to plantar heel pain when running. 

Strappal and K-Tape that can be used for taping

Intrinsic Muscle Strengthening

These are exercises designed to strengthen the muscles within the foot. The idea being the stronger they are the less stress will be applied to plantar fascia helping it to heal. 


Summary


Plantar Heel pain or Plantar Fasciitis is a common condition that can be painful and cause issues with walking. Unfortunately it has complicated multifactorial causes and no one treatment will work for everyone and it is often miss-diagnosed.

Generally in our clinic we will recommend stretching, strengthening,  taping and insoles to get your back pain free as quick as possible.


Differential Diagnosis


Plantar Fibromatosis

  • Pain increases with activity
  • Fibroblasts are palpable

Lateral Plantar Nerve Entrapment

  • Burning sensation over the inside of the arch
  • Pain radiates
  • Altered sensation

Bone Tumour / Neuropathic pain

  • Pain Occurs at night

Bursitis

  • Located in centre of heel
  • Palpable mass
  • Result of repeated trauma



Contact Details

Email: [email protected]


Call: 0141 440 1999


Address: 603 Helen Street, Glasgow, Scotland, G51 3AR


Online Booking:  Buchanan Clinic Appointments




  




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