Plantar Heel Pain

This is quite a common condition that can affect just about anyone. It is general term for pain on bottom part of the heel of the foot and may be a result of many causes. The most common that we see is plantar fasciitis, also known as plantar fasciopathy or plantar fasciosis. No matter what it is called, it hurts!

This condition will most often give rise to pain on the bottom of the heel, usually also at the beginning part of the main arch of the foot. Patients often experience pain in the morning when getting out of bed for the first few minutes of walking. The pain often improves or dissipates entirely until such time as you sit or rest for a period and get up to walk again and you are suddenly reminded by the sharp pain under your foot!

There are many possible causes which may include a sudden increase in your level of activity, a change in the type activity, a change in footwear or worn out footwear, walking on a different surface and even changing occupations. Previous injury is often a precursor, especially if the injury has been an ankle sprain or strain, or even simply tightness in your calf muscles. Weight gain is also associated with plantar heel pain for not only the obvious reason but also due to potential metabolic syndrome which may be characterised by abdominal obesity, high cholesterol, insulin resistance and high blood pressure.

Plantar heel pain is often a result of increased load on the plantar fascia which is a band of tissue that attaches to the heel and fans out as it inserts in the bottom of the toes. When the joints of the toes bend, particularly the big toe joint, it tightens the fascia which enables it to assist in supporting and stabilising the foot for effective forward movement. There may sometimes be a problem with the way the joints work which results in abnormal function and load of the plantar fascia.

There are many ways to manage plantar heel pain but the first is to come up with an accurate diagnosis. Often, we will refer for ultrasound and/or x-rays to help us make that diagnosis so that we may design a suitable management plan. Treatment may include prescribed stretching exercises, targeted strengthening or loading exercises, mobilisation of restricted joints, foot taping, footwear advice, exercise modification and custom designed foot orthoses (insoles/arch supports). A multidisciplinary approach is sometimes employed with referral to physiotherapists and biokineticists.

Other treatment options include extracorporeal shockwave therapy, ultrasound guided cortisone injection, radiotherapy, non-steroidal anti-inflammatories, night splints, platelet-rich-plasma infiltration and lastly surgery.

Byron Starkey, Podiatrist.

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