Step Ahead of Heel Pain: Understanding & Treating Plantar Fasciitis

Plantar fasciitis is irritation or inflammation of the fascia which runs along the base of the foot. Also known as plantar heel pain or plantar fasciopathy, it is one of the most common complaints of patients with foot pain. The fascia connects the base of the heel to the base of the toes; it supports the arch of the foot & helps to distribute forces as we walk or run.

Diagnosis is based on symptoms, the individual's history and a thorough physical examination. Usually this pain is described as sharp, stabbing or burning in the heel or sole of the foot; usually worse following a period of rest. In this blog, I’ll be exploring some of the causes and common management strategies we can utilise to help if you are suffering from plantar fasciitis.

Starting with the some of the common causes:

Tight calf muscles

There is a close link with heel pain and tight calf muscles. Tight calf muscles can limit ankle range of motion which in turn can put extra strain on the plantar fascia causing pain in this area.

Suboptimal biomechanics

Individuals who have either flat feet or high arches are at greatest risk of developing plantar fasciitis. With flat feet, the arch of the foot collapses, causing the fascia to stretch away from where it attaches on the heel bone which causes it to become inflamed. With high arches, the fascia is often tight which can cause a lot of tension and pain in the same area.

Footwear

When we wear shoes that don’t provide adequate support for the foot over a prolonged period of time, it places more pressure on the plantar fascia causing strain. Some common problematic shoes are thongs (flip flops), minimalist running shoes, ballet flats or sandals.

Weight

Carrying extra body weight is a risk factor for developing plantar fasciitis. The more we weigh = more pressure placed on the lower limb structures; especially our feet. This can cause extra strain to be placed through the plantar fascia as it is attempting to support the arch of the foot appropriately and to distribute the forces of our movement through the foot.

Gender

Females are unfortunately at higher risk of developing plantar fasciitis. This risk is also increased during pregnancy due to sudden weight gain and ligament laxity.

Age

People aged between 40-70 are at greatest risk of developing plantar fasciitis.

Occupation

Individuals who have jobs that require them to be on their feet for long periods of time also have an increased risk of developing plantar fasciitis.

TREATMENT METHODS

Now onto the management strategies. Unfortunately, there is still insufficient high quality research that provides clarity surrounding the most effective management strategy for plantar fasciitis. Saying this, there are multiple different treatment options for plantar fasciitis and every patient should be assessed and treated using an individualised approach. A recent systematic review identified stretching, foot taping and education in regard to load management, footwear and weight management to be the most beneficial for managing plantar fasciitis.

Stretching

One of the key management strategies is stretching both of the calf muscles, the Gastrocnemius & Soleus. This can help increase range of motion at the ankle, therefore reducing strain through the plantar fascia, providing a reduction in pain and long term prevention of recurrence.

Taping

This can be used to alleviate stress on the plantar fascia by limiting the movement of the fascia. Due to this, it can help to relieve the pain and inflammation associated with it. This is a very simple method that can be utilised for a short period of time. Taping should be used alongside other management strategies discussed within this post.

Activity modification

This involves temporarily reducing or avoiding high impact activities and participating in low impact/non weight bearing exercises such as swimming or cycling to allow the fascia time to heal. Once the significant pain has settled, you can start to introduce higher impact activities with careful monitoring of symptoms and adjusting intensity or duration as required.

Weight loss

Advice on weight management can be utilised in order to help reduce the load through the plantar fascia. This is not always the easiest management strategy due to pain usually being a limiting factor in increasing physical activity in order to lose weight, but it is completely possible to do with the right guidance. Choosing comfortable supportive footwear, increasing activity gradually, incorporating low impact exercises and diet management can all be utilised to help with weight loss.

Orthotics/Insoles

For individuals with suboptimal biomechanics, custom made orthotics or insoles can help to support the arch of the foot which helps to unload the plantar fascia and reduce pain.

Footwear

A podiatrist can recommend specific shoes that will be appropriate for supporting the arch of your foot correctly. Currently, there is no credible scientific evidence relating to the effectiveness of plantar fasciitis shoes.

Strength training

There is minimal high quality evidence that suggests strength training alone is what we should be using to treat plantar fasciitis. There is an obvious gap in the research which needs to be investigated further. Now saying that, it continues to be used alongside other treatment methods such as taping, stretching & activity modification depending on the individual’s goals. If you are wanting to return to high impact activities/sports then strengthening should definitely be part of your management plan.

Medical intervention

Corticosteroid injection (CSI) has been used to treat plantar fasciitis even though it increases the risk of rupture. Now, some research has identified that utilising CSI alongside strength training could be a good management option, one limiting factor is that this is a result from a low quality study. If considering a CSI, it is recommended you have exhausted all other management options due to the risks associated with it.

With the right mix of movement, support, and patience, every step forward can bring you closer to leaving heel pain behind and walking with confidence again!