#PodsHealHeels

Plantar Fasciitis

As its #podshealheels fortnight here's a blog on the number one cause of heel pain, Plantar Fasciitis (PF).

PF is the the most common form of heel pain, affecting 1 in 10 adults at some point. With women more likely to suffer from the condition then men, and those aged 40 - 60 most likely to be affected.

If you have to stand or walk on hard surfaces for prolonged periods you are also at an increased risk of developing the condition as are long distance runners. In fact PF accounts for around 10% of all injuries which occur due to running.

Other risk factors include diabetes, high arched feet, weight, a reduced ankle joint range of motion, flat feet, an increase in activity and the wearing old or poor quality footwear. The fact that people are going for walks or running more, and going bare foot or in slippers whilst working from home may explain why there has been an increase in heel pain during the lockdowns.

So what is PF? PF is when the plantar fascia a fibrous soft tissue structure that runs from your heel to the base of your toes is damaged. The main function of the plantar fascia is to support the arch of your feet and it plays an important role in walking. The condition is often described as an over use injury, meaning its repetitive small injuries rather than one event.

Normally people become aware of the problem over time, finding it hard to define when it started or what triggered it. Patients typically complain of an exquisite sharp pain on standing/walking when getting out of bed in the morning, of it easing with movement, and then worsening again in the evening. Pain is typically felt under the heel.

PF is diagnosed primarily on a physical examination and medical history. Imaging isn’t normally required.

Treatment of PF varies from patient to patient but in nearly all cases a stretching and strengthening program will be recommended as in 52% of all patients see an improvement in stretching alone. I provide a stepped program moving from static to more dynamic exercises as the patient progresses. I also always look at footwear and whether it is hindering recovery.

Other treatment options I regularly use include strapping, temporary insoles and orthoses (both over the counter and cast devices) but ideally these will be used short term.

There are also some devices I recommend to help with the rehabilitation program, including a pediroller, a small plastic device you can put in the freezer to roll under your foot, both stretching the plantar fascia and also aiding with it being cold. Another device is the plantar pad which helps make heel raises more effective. And also a large towel to aid stretches.

There are other treatments for PF if these don’t help including steroid injections and shockwave therapy and whilst I don’t currently offer these I have good links with specialists and podiatric surgeons I can refer on to.

However it is worth noting that even though PF is the most common cause of heel pain, it is also an over diagnosed condition and that there are many causes of heel pain which is why seeing a podiatrist and getting a diagnosis based on history and physical examination is so important.