Heel Pain & Plantarfasciitis

Plantar fasciitis is one of the most common sources of heel pain, and many of the factors that cause it are also involved with other types of heel pain, although a thorough physio assessment to rule out similar diagnoses is essential.

Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.

Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.


What Causes Plantar Fasciitis?

Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods.

They are either traction or compression injuries.

Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles.

It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.

Traction Plantar Fasciitis - Plantar fasciitis symptoms are usually exacerbated via "traction" (or stretching) forces on the plantar fascia. In simple terms, you plantar fascia is repeatedly overstretched. The most common reason for the overstretching are an elongated arch due to either poor foot biomechanics (eg overpronation) or weakness of your foot arch muscles.

Compression Plantar Fasciitis - Compression type plantar fascia injuries have a traumatic history. Landing on a sharp object that bruises your plantar fascia is your most likely truma.

The location of plantar fasciitis pain will be further under your arch than under your heel, which is more likely to be a fat pad contusion if a single trauma caused your pain.

The compression type plantar fasciitis can confused with a fat pad contusion that is often described as a "stone bruise".

What are the Symptoms of Plantar Fasciitis?


You'll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting.

Your heel pain will be worse with the first steps and improves with activity as it warms up.


Risk Factors for Plantar Fasciitis

You are more likely to develop plantar fasciitis if you are:

>  Active - if you have tight calf muscles or a stiff ankle

>  Overweight

>  Pregnant

>  On your feet

>  Flat feet or high foot arches

>  Middle-aged or older

>  Wearing shoes with poor support

>  Weak Foot Arch Muscles

>  Arthritis

>  Diabetes


How Does Plantar Fasciitis Progress?

As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines:

1           No Heel Pain - Normal

2     Heel pain after exercise

3     Heel pain before and after exercise

4     Heel pain before, during and after exercise

5     Heel pain all the time. Including at rest!

This symptom progression is consistent with a typical overuse injury.


How is Plantar Fasciitis Diagnosed?

Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination.

After confirming your plantar fasciitis they will investigate why you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts.

Your physio will also rule out other potential causes of heel pain, including nerve entrapment, stress fractures and referred pain.

X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur.

Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.

Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.


Plantar Fasciitis Treatment

The good news is that plantar fasciitis is reversible and very successfully treated. About 90 percent of people with plantar fasciitis improve significantly within two months of initial treatment.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid).

Cortisone injections have been shown to have short-term benefits but they actually retard your progress in the medium to long-term, which usually means that you will suffer recurrent bouts for longer.


Due to poor foot biomechanics being the primary cause of your plantar fasciitis it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development of a heel spur.

Your physiotherapist is an expert in foot assessment and its dynamic biomechanical correction. They may recommend that you seek the advice of a podiatrist, if orthotics are required.


Physiotherapy Treatment

Research has shown 8 components of rehab that are required for best treatment of plantarfasciitis.  

These are:

>  Pain relief & relative rest -  including use of ice, anti-inflammatory

     medication and taping or heel cups to make walking more

     comfortable

>  Range of motion - restore movement using hands on techniques

     and exercises

>  Restore foot intrinsic muscle control - to lift the arch

>  Restore normal calf & leg muscle control

>  Restore normal foot biomechanics

>  Footwear analysis - of sport, work and other regular footwear

>  Improve running & landing technique - this may include a

    FLEX Running Screening

>  Return to sport