While heel pain may not seem as serious as other health problems, anyone who’s ever dealt with plantar fasciitis knows how agonising and distressing the condition can be. In addition to causing pain, it can leave people out of action, off their feet and unable to participate in the activities they love.
Plantar fasciitis refers to pain at the bottom of the foot, on the heel and around the arch of the foot. The plantar fascia is a thick, fibrous band that connects the heel to the toes and when it becomes inflamed through overuse or overstretching or not being supported correctly, it can cause debilitating pain.
“The plantar fascia acts as a big shock absorber through the foot. If something doesn’t stretch as well, you find fundamentally it starts to get damaged,” osteopath Dr Andrew Jacobs tells Starts at 60.
Instead of it stretching and returning back to its normal shape, the plantar fascia can pass its stretching point, stress and cause damage and inflammation. Putting stress on the heel bone through physical activity, standing or walking for long periods, wearing certain footwear and even ageing and obesity can lead to the development of plantar fasciitis.
The condition is caused by either an overuse injury or an unsupported injury. An overuse injury occurs when someone goes from an activity they normally do but increases it dramatically.
“It might be someone that’s quite sedentary and they go, ‘Oh, it’s a nice day. I’ll go for a big walk’. They go for a big walk, it overuses that tendon in the plantar fascia and they start to get sore,” Dr Jacobs explains. “Once it gets sore it’s kind of a snowball effect and gets worse and worse.”
Unsupported injuries occur when the arch of the foot isn’t supported properly and are common if someone wears flip flops or footwear that is unsupportive.
“Because it’s not supporting the arch, it’s putting a lot more pressure on the plantar fascia. Over time, it overuses it and it starts to get sore,” Dr Jacobs says.
The symptoms of plantar fasciitis are quite specific and it’s typically easy for a practitioner to make a diagnosis. For example, people with plantar fasciitis will notice pain in their heel or mid-foot when they put weight on it or when doing physical activity.
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While the pain can be concerning, plantar fasciitis is an issue in itself and won’t point to other foot problems. Still, it’s important to talk to a GP, osteopath or podiatrist for a proper diagnosis and so the best treatment options can be explored.
Health professionals use a patient’s history and explanation of symptoms to diagnose, while MRIs or ultrasounds can also be used to understand the complexity of the issue in more serious cases.
“Clinically, it’s very hard to differentiate if it’s plantar fasciitis or if there’s a tear in the plantar fasciitis, but if you use ultrasound or MRI, you can help get a better diagnosis of it all,” Dr Jacobs explains. “Having the MRI or ultrasound can help confirm exactly what it is and make sure you’re getting the correct management for it.”
While some people deal with plantar fasciitis in the short term, others experience it for years and treatment depends on which stage people are at. Someone who’s simply overworked their plantar fascia will benefit from basic treatments such as using ice to reduce inflammation, resting, taping the foot or wearing orthotics that relieve the muscle tension and take the pressure off the plantar fascia.
“You can do a little bit of massage to the foot and just let it heal and settle down,” Dr Jacobs says.
For more complex and chronic problems, osteopaths can perform soft tissue work and osteopathic treatment to the plantar fascia and surrounding structures.
“We know that with plantar fasciitis, a lot of the time there’s a lot of tightness in through the muscles through the whole leg and that’s putting more pressure in there,” Dr Jacobs explains.
Shock wave therapy may also be offered when conservative management fails. It works by sending shock wave pulses through the plantar fascia to stimulate the healing process. PRP injections – which sees plasma-rich platelets injected into the plantar fascia – can also stimulate the healing process.
“We tend to try to be very conservative at the start and then we look at some osteopathic or some manual treatment. If they fail, you can start to utilise the shock wave or the injections for more of those stubborn conditions that don’t settle down,” Dr Jacobs says.
The key to preventing heel pain is to take action. Unlike other health conditions that can improve on their own with time, plantar fasciitis can affect people for years and speaking to a health professional is the best starting point.
“It’s not saying they need to have treatment, it’s just starting to use the right management tools to make sure they’re getting on top of it,” Dr Jacobs says. “They’re more likely to resolve the problem and fix it rather than just letting it go and hoping it gets better.”
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