WHAT IS IT?
Plantar fasciitis Is a very common cause of heel pain. It can be quite debilitating and can last for months if not addressed. Typically, pain will be felt on the inside of the heel and arch. Pain can be sharp or achy. There can be a small amount of swelling over the medial heel as well as tenderness to touch. Mornings are worse, with it usually taking anywhere from 2-3 minutes to an hour for the stiffness and pain to reduce.
POSSIBLE CAUSES
· Change in load eg Running/jumping
· Change in footwear
· Change in activity surface eg. Hard surface
· Acute trauma eg. Stepping on a rock
SCANS
Sometimes your GP will refer you for a scan of the affected area. Most likely it will be an x-ray or an ultrasound. This may show that there are heel spurs or “tears” in the plantar fascia. Although it can be good to confirm the diagnosis, scans can sometimes be detrimental as it may cause people to become worried about their condition. Scan results can also correlate poorly with symptoms an example being that people with heel spurs on x-ray don’t necessarily develop Plantar fasciitis.
TREATMENT OPTIONS
· Soft tissue release
· Joint mobilisations
· Taping techniques
· Orthotics
· Exercise program (Physiotherapist prescribed)
· Load management plan (Physiotherapist prescribed)
LOAD MANAGEMENT
Load management is about controlling how much you use the particularly area on a day to day basis. Usually when an area becomes painful, its load capacity (ability to tolerate load) is reduced so it becomes overloaded quicker than normal. This means that even normal tasks or activities like walking or standing can cause it to become more painful and swollen.
One of the ways to improve the capacity is to progressively build up the amount that you use that area. This can be done with a specific structured exercise program (physiotherapist prescribed) that is made more difficult over a period of time. It is normal for rehabilitation to be painful, you cannot improve load tolerance without causing some discomfort.
The best way to monitor improvement is by recording morning pain (rating it out of 10, 10 is worst, 0 is nothing). It is normal to have ongoing morning stiffness even after pain has completely disappeared.
DIFFERENTIAL DIAGNOSIS
Sometimes Plantar fasciitis might not be the cause of heel or foot pain. It is important to see a physiotherapist to get an accurate diagnosis. Other causes of heel pain are below:
· Plantar or Calcaneal Nerve pain
· S1 radiculopathy
· Stress fracture
· Tarsal tunnel syndrome
· Fractures
· Retrocalcaneal bursitis
· Spondyloarthropathies
· Cancer (osteoid osteoma)
TIPS FOR PAIN FLARE UPS
· Try to avoid walking around in bare feet
· Using ice over the sore area can give temporary relief
· Stretching it may be uncomfortable so roll a golf ball/tennis ball under the foot instead to release tight muscles
· Pain relief or anti-inflammatory medication can be helpful but ask your pharmacist for advice
· See your physiotherapist for a progressive loading program