Plantar Fasciitis Heel Pain

Plantar Fasciitis/Heel Pain

Plantar Fasciitis /Heel pain is a common foot condition. It’s usually felt as an intense pain when using the affected heel.
Heel pain usually builds up gradually and gets worse over time. The pain is often severe and occurs when you place weight on your heel.

What is the Plantar Fasciitis?

The plantar fascia is a tough and flexible band of tissue that runs under the sole of the foot. It connects the heel bone with the bones of the foot, and acts as a kind of shock absorber to the foot.  In most cases, only one heel is affected, although estimates suggest that around a third of people have pain in both heels.

Most cases of heel pain are caused when the Plantar Fascia becomes damaged and thickens.
Plantar fasciitis is the medical term for the thickening of the plantar fascia. The pain is usually worse first thing in the morning, or when you first take a step after a period of inactivity. Walking usually improves the pain, but it often gets worse again after walking or standing for a long time.

Some people may limp or develop an abnormal walking style as they try to avoid placing weight on the affected heel.

What causes heel pain?

Sudden damage – for example, damaging your heel while jogging, running or dancing; this type of damage usually affects younger people who are physically active
Gradual wear and tear of the tissues that make up the plantar fascia – this usually affects adults who are 40 years of age or over.

Sudden damage, or damage that occurs over many months or years, can cause tiny tears (microtears) to develop inside the tissue of the plantar fascia. This can cause the plantar fascia to thicken, resulting in heel pain.
The surrounding tissue and the heel bone can also sometimes become inflamed.

Who is at risk of getting Plantar Fasciitis?

You are at an increased risk of gradual wear and tear damaging your plantar fasciitis if you:
are overweight or obese – if you have a body mass index (BMI) of 30 or over you’re considered obese
have a job that involves spending long periods of time standing
wear flat-soled shoes – such as sandals or flip flops

What are the other causes of Heel Pain?

  • Some less common causes of heel pain are described below.
  • Stress fracture.  A stress fracture (crack in the bone) can occur if your heel bone is damaged following repeated stress over time.
  • Fat pad atrophy.  Fat pad atrophy is where the layer of fat that lies under the heel bone, known as the fat pad, starts to waste away due to too much strain being placed on it. Women who wear high-heeled shoes for many years have an increased risk of developing fat pad atrophy.
  • Bursitis.  Bursitis is inflammation of one or more bursa. Bursae are small fluid-filled sacs under the skin that are usually located over the joints and between tendons and bones.
  • Tarsal tunnel syndrome.  The nerves in the sole of your foot pass through a small tunnel on the inside of the ankle joint called the tarsal tunnel.  If a cyst forms or the tunnel is damaged, the nerves can become compressed (squashed). This can cause pain anywhere along the nerve, including beneath your heel.
  • Sever’s disease. Sever’s disease is a common cause of heel pain in children. It’s caused by the muscles and tendons of the hamstrings and calves stretching and tightening in response to growth spurts.The stretching of the calf muscle pulls on the Achilles tendon. This pulls on the growing area of bone at the back of the heel (the growth plate), causing pain in the heel.   The pain is further aggravated by activities such as football and gymnastics. The pain often develops at the side of the heel, but can also be felt under the heel.  Calf and hamstring stretches and, if necessary, heel pads are usually effective treatments for Sever’s disease.
  • Bone spurs.  Bone spurs are an excess growth of bone that forms on a normal bone. They can develop on the heel (a heel spur), and are more common in people with heel pain. However, they can also occur in people without heel pain, and a heel spur itself doesn’t cause heel pain.

What can I do about my Heel Pain/Plantar Fasciitis?

  • Rest your foot.  This should be done as much as possible. Avoid running, excess walking or standing and undue stretching of your sole. Gentle walking and exercises described below are fine.
  • Footwear.  Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support. A laced sports shoe rather than an open sandal is probably best. Avoid old or worn shoes that may not give a good cushion to your heel.
  • Heel pads and arch supports.  You can buy various pads and shoe inserts to cushion the heel and support the arch of your foot. These work best if you put them in your shoes at all times. The aim is to raise your heel by about 1 cm. If your heel is tender, cut a small hole in the heel pad at the site of the tender spot. This means that the tender part of your heel will not touch anything inside your shoe. Place the inserts/pads in both shoes, even if you only have pain in one foot.
  • Pain relief.  Painkillers such as paracetamol will often ease the pain. Sometimes anti-inflammatory medicines such as ibuprofen are useful. These are painkillers but also reduce inflammation and may work better than ordinary painkillers. Some people find that rubbing a cream or gel that contains an anti-inflammatory medicine on to their heel is helpful.An ice pack (such as a bag of frozen peas wrapped in a tea towel) held to your foot for 15-20 minutes may also help to relieve pain.
  • Exercises.  Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. This is because most people with plantar fasciitis have a slight tightness of their Achilles tendon. If this is the case, it tends to pull at the back of your heel and has a knock-on effect of keeping your plantar fascia tight. Also, when you are asleep overnight, your plantar fascia tends to tighten up (which is why it is usually most painful first thing in the morning). The aim of these exercises is to loosen up the tendons and fascia gently above and below your heel. Your doctor may refer you to a physiotherapist for exercise guidance.  Give us a call. Evidence shows that loading the foot doing weight bearing exercises is also effective in the treatment of Heel Pain.

Are there other treatment options?

When symptoms are persistent and a patient has been fully compliant with physiotherapy consisting of stretches and loading exercises you may be referred for a steroid injection. There is also some evidence for Extracorporeal Shockwave therapy, although this is not available locally on the NHS.

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