Heel pain, policeman’s heel, plantar fasciitis…whatever you choose to call it, it is a common condition that can really impact on your day. In my clinic, I see at least one person every day who is complaining of heel pain which limits or severely impacts on their daily activity.
So….what is it?
Our foot is a complex structure made up of 26 bones and many tendons and ligaments. The structure encased on the plantar aspect (bottom of the foot) by a tight band called the ‘plantar fascia.’ The band spans the length of the foot from its main insertion at the heel, to the many insertions it makes at the toes. Injury to this band causing pain is called ‘plantar fasciitis’ (PF).
PF is caused due to overload of stress. The feet support the weight of our whole body and allow us to move. The injury can be caused by different factors in different people and can either be chronic (long term) or acute (sudden onset). Understanding why it happens can ensure you get the best treatment for your condition. The current thinking is that osseous bone spur formation is a direct result of the body trying to increase the weight bearing load area of the heel bone (calcaneum).
Imagine the plantar fascial band is like an elastic band. With every step that you take that elastic band stretches and contracts. This pressure over man steps can cause a small inflammation at the insertion, then the repeated following steps cause more and more micro trauma to the area. This results in pain and inflammation over a long period of time.
A change of activity or footwear that puts a vast amount of pressure through the band of fascia causing overload and injury.
In chronic PF, the pull of the plantar fascial band on the heel bone (calcaneus) can cause the bone to ‘over heal’ itself and causing a calcification around the insertion point of the band.
So…what causes it?
Many different factors can cause PF, and causes vary from person to person. Essentially the cause always has a biomechanical root, ie the foot is not functioning optimally for the task that it is trying to carry out. Common causes are:
*overpronation/ “flat feet”
*muscle tightness in the calf/hamstring muscles groups
*muscle weakness in the foot
*change of activity e.g. taking up a new sport
*climbing ladders/carrying heavy objects
Treatments can vary from person to person. Every person with PF can benefit from a biomechanical assessment with a podiatrist. This will look at how your feet function on their own, and in relation to the rest of the body. Following on from this the practitioner will often:
These are specialist insoles which are worn inside your shoes and help to ensure the foot functions correctly. They also help to hold your foot in an ‘at rest position’ meaning pressure is relieved from the area.
- Stretch and strengthening programme
Calf stretches are important in every person suffering with plantar fasciitis. If the calf muscles are elongated, this releases the upward pull of the calf muscles onto the heel so can ease the restriction. Strengthening of the muscles that support the arch is also important.
It is important to rest the area from your sporting activities as much as possible, and to not continue through the pain as this can do further damage and mean treatment takes longer. Aim to Ice the area 1-2 x daily.
Kinesio tape can be very effective in helping to alleviate the pain caused by PF. Zinc oxide tape may be used to strap the heel in certain cases.
Low level laser therapy (3LT) can accelerate and enhance healing. 3LT has an FDA market learance to be effective in the treatment of plantar fasciitis. The application of healing red 635 nm wavelength can increase cellular energy; adenosine triphosphate (ATP) to initiate release of growth hormones, fibroblasts, collagen and elastin renewal.
- Soft tissue and joint mobilisation
When we have pain, our body ‘tenses up’ and therefore movement is restricted. With restricted movement you can then have ‘new pain’ as the foot function is impaired. By mobilising the joints and soft tissues, the foot is able to function optimally. The blood flow can improve which also means healing is accelerated.
Ensure all sports shoes are always fitted correctly in a reputable sports shop. Bring a selection of footwear to a biomechanics appointment so that the podiatrist can give you advice on what footwear is best while you recover. Important to wear a small heel to alleviate traction stresses on fascia.
You should aim to roll your foot on a golf ball or frozen water bottle daily to try and release muscle pressure in the area.
Platelet rich plasma therapy is very effective in the treatment of plantar fasciitis. Injections of concentrated plasma made by a patient’s own blood being centrifuged can be injected safely into the area around the plantar heel fascia insertion to stimulate repair. PRP is a concentrated source of growth factors and bioactive proteins required for healing.
Steroid injections can be performed under ultrasound to treat plantar fasciitis, but these are a last result until all conservative methods have been tried. It is important to treat the cause of plantar fasciitis e.g. address poor biomechanics and not just the symptoms.
Shock wave therapy is literally what it says on the tin. Applying targeted shock wave energy directly over the painful heel area to cause an analgesic effect and encourage healing responses.
But Remember! Each patient is different and each person will take different lengths of time to recover, some recovering quickly, some taking a bit more work. This is the same with any injury, but patience and perseverance are the key to success.