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Heel pain: all your questions answered.

06 Dec 2018 | Liam Rothwell

Heel pain: all your questions answered

Heel pain, plantar heel pain or Plantar Fasciitis, is pain at the bottom of the heel. There are many factors that could cause plantar heel pain. In this post we give you some stats and facts about this condition and answer some questions that we frequently hear asked in our clinics.


Plantar Fasciitis – the facts

  • Plantar Fasciitis affects 1 in 10 people
  • It’s most common in people between 40 and 50 years of age
  • And can occur in anyone from athletes to those that live a sedentary life


Do I have Plantar Fasciitis?

If you have pain at the bottom of one or both heels that is worse in the morning or after rest, then you could have Plantar Fasciitis – a condition which is an injury of the thick band of tissue on the sole of the foot known as the plantar fascia.


What is Plantar Fasciitis?

The plantar fascia is a structure which starts at the heel bone and runs under the arch to the ball of the foot. It’s main purpose is to keep the bones and joints in position and to support the arch of the foot. With repeated activity on our feet, this soft tissue can stretch, and become tight and weak, which can result in small tears and inflammation.The fascia then tries to repair itself but becomes thickened and degenerative which reduces its function and results in chronic stress and pain on this particular part of the foot.

The condition usually affects where the fascia attaches to the heel bone, but sometimes it can also affect the middle of the foot. You might also suffer from other symptoms such as calf-muscle cramps. The heel pain itself can be worse first thing in the morning with a sharp pain on first step, after standing for long periods and with exercising.

What causes Plantar Fasciitis?

  • Most injuries to the plantar fascia are caused by a change in normal load patterns through the muscle. In other words, there is more pressure on the plantar heel than it can tolerate.
  • The biomechanics of your feet can also cause the condition, for example if you have flat feet, it may cause the fascia to overstretch as the foot rolls in and the arch flattens. A high arched foot may also result in increased pressure on the heel.
  • Reduced ankle mobility and calf muscle tightness or weakness can result in an increase of pressure at the Achilles tendon attachment at the back of the heel bone, which may then result in tension on the plantar fascia at the front of the heel bone.
  • Being overweight (having a high BMI) can add extra load to the foot and is seen to be a major risk factor for plantar heel pain
  • Weakness of intrinsic muscles within the foot can cause an increased pressure and reduced shock absorption capacity of the foot and heel.  
  • Inappropriate shoes can also be a common cause of heel pain. If you’ve got calf tightness avoid flat shoes which can stretch and stress the plantar fascia more; if you’ve got poor shock absorption avoid thin soled shoes
  • Standing, running or jumping on hard surfaces can also cause heel pain.

The common theme across all of these factors is that they all place extra stress on the plantar heel.


Can anyone suffer from heel pain?

Anyone can suffer from Plantar Fasciitis, but certain groups are at increased risk. These are:

  • Women, and particularly during pregnancy, but also men in the 40-50 age group
  • Physically active people or those who commence or increase intense activity
  • People who are overweight
  • People who are on their feet for long periods of time

How does it affect people?

At first, it is usually mild so it’s not unusual for people to just ignore it. It may even disappear without treatment. If it persists it can become chronic and debilitating, inhibiting your usual movement and limiting everyday life activities, which causes people to seek advice and treatment from a specialist.


What are heel spurs and how are they related to heel pain?

In many cases, plantar heel pain is associated with a heel spur. You can’t see them but they will show up on an x-ray and may cause a tender patch at the heel on the sole of the foot. A heel spur is where the plantar foot muscle tears and bleeds where it attaches at the heel and, over time, these injuries calcify and form a painful outgrowth off bone.

How would my Podiatrist diagnose Plantar Fasciitis or any other cause of plantar heel pain?

Your Podiatrist will take a detailed history, analyse your commonly worn footwear and conduct a physical assessment of your foot and lower limb function. They will feel around the site of pain to get an understanding on the integrity of the structures in the area. An X-ray and ultrasound is usually recommended.


How can I relieve my heel pain at home?

If the pain is recent, treatments such as ice, rest and anti-inflammatories may be helpful. If the pain has been present for months, treatments such as a tennis or golf ball massage, heat and stretching can be beneficial. The aim is to reduce whatever pressure is causing the pain so wearing supportive cushioned footwear is usually recommended to make things more comfortable.


How is Plantar Fasciitis treated?

‘Will it go away on its own’ and ‘how long will it take to get better’ are common questions patients ask when seeking to resolve this frustrating and chronic pain.


Your Podiatrist will assess, diagnose and develop treatment plans depending on the cause. There are many options depending on the severity of the condition and the focus is on reducing the causes of stress on the feet.

  1. Rest – avoiding the activity that caused the pain in the first place. This may include long walks, long periods of standing and running
  2. Stretches and flexibility exercises – doing simple calf muscle stretches before standing
  3. Regular foot massage – concentrating on the arch and heel of the foot
  4. Reducing the initial inflammation – applying ice and using anti-inflammatory medicines (topical or oral)
  5. Checking your posture and walking style – correcting imbalances and gait abnormalities that may contribute to the pain
  6. Supportive footwear – wearing shoes that have a cushioned heel and midsole support
  7. Foot supports – professional strapping, a splint worn at night or orthotics (shoe insoles) to temporarily adjust the biomechanics of the feet and other assistive devices or insoles which can help correct foot faults and cushion and support the arch during the healing process.
  8. Shockwave therapy
  9. Corticosteroid injection
  10. In severe cases, a Moon Boot may be recommended
  11. Surgery is a final and last resort to repair the damaged plantar fascia


How can Plantar Fasciitis be prevented in the first place?

You can reduce the risk of heel pain occurring in the first place, in many ways, including:

  • Wearing shoes that fit you well with a firm fastening
  • Choosing shoes that are appropriate for your activity such as with shock-absorbent soles or a supportive arch
  • Replacing any shoes that are worn out
  • Always warming up and cooling down when exercising including massage and stretches
  • Avoiding repetitive stress, pressure and pounding of the heel. This may include not standing in the same position for a long time or choosing less weight bearing exercise activities if you’re carrying extra weight.

Most people usually suffer from heel pain for months if not years. Early recognition and treatments help reduce the chances of the conditions becoming chronic and stubborn. If you are currently suffering from heel pain or know someone who is please ask them to read this or contact us should they have anymore questions or require a review. We have a specific and holistic treatment program designed to gain quick relief from the pain along with promote healing and a stronger fascia, foot and lower limb to ensure the injury never returns.