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Plantar Fasciitis – City to Surf

4th August 4, 2015

It’s that time of year again and the recreational walkers / runners are out and about, training for this annual event. In just 5 days, on August 9th, troops of people, young and old, fit or flabby, male or female will be pounding the roads that head East from the Sydney CBD to the shores of Bondi Beach. It’s about this time each year that we see plenty of new patients in the clinic, each turning up with injuries such as Heel Pain, Shin Splints, Plantar Fasciitis or calf strains. It’s no surprise to us as Sports Podiatrists as we understand the causes of such conditions, but the recreational runner doesn’t.

Zero to hero

As I have said in many of my previous articles, you are highly likely to develop Plantar Fasciitis, Heel Pain, Achilles Tendonitis and other conditions such as Shin Splints, if you increase your level of activity too quickly. It’s so important to start low and go slow. This allows the body to adjust. It’s known as conditioning, and its overlooked far too much. Your foot and leg muscles need to strengthen throughout the course of your training, and recover. Rest days in between will allow growth and repair. The tightness in the muscles which develops as you increase activity is a problem, but this can be helped by stretching and by resting in between exercise days.

Tight muscle groups

The tight muscles create bio-mechanical in-efficiencies. Calf muscles, hamstrings, quadriceps and glutes. These all affect stride and foot function. The straw that breaks the camels back is the tightness in the calf muscles which creates pulling on the heels. This is one of the most obvious causes of Heel Pain, and Plantar Fasciitis, as well as Achilles tendonitis. Nearly every patient that I treat for Plantar Fasciitis has tight calf muscles! Its no co-incidence – If you have tight calves, you are highly likely going to develop some form of Heel Pain. If you want to avoid conditions such as Plantar Fasciitis then pay attention to your calf muscles during your training regime.

The hills are out to get you!
Here’s a simple fact… Walking or running up hills loads your calf muscles. Therefore, your calf muscles will become fatigued and will feel tight the more you hit the hills. We all know about the hills that are involved with City to Surf so it’s important to stretch calves regularly to avoid Heel Pain. It’s no coincidence that a large percentage of new patients that we treat for Plantar Fasciitis have been hill training. Yes it’s a great work out, but yes you’re more likely going to develop Heel Pain. Introduce the hills slowly, and have those rest days in between.
Muscle replenishment
Personally, I’m a big fan of Endura drinks. sodium, potassium and magnesium. Your muscles are depleted of these trace elements the more you exercise. You can drink these products before, during and after training. These drinks can help you feel better and reduce fatigue and there’s a chance they might help with that calf muscle tightness too. So in a way, Endura drinks are helping with Plantar Fasciitis and other causes of Heel Pain.
A final word
Enjoy the day, enjoy the race, and enjoy the social gatherings in Bondi Beach afterwards. I’m sure many of you will head straight to cafes and eateries for breakfast / lunch, depending upon what time you arrive, but don’t forget to warm down and stretch. The important muscle groups after such a hilly run are quads, hamstrings, calves and gluts. And if we really want to avoid Heel Pain and Plantar Fasciitis then we know we really have to commit to the calf stretch. Hold each stretch for at least 30 seconds and do each leg 3 times. See below:

CALF STRETCHES

  • One foot back, one foot forward
  • Both feet point directly ahead
  • Back heel stays on ground – do not lift
  • Back knee straight
  • Make an arch – Roll that back foot to the outside edge slightly to stop foot collapsing but keep hips centered
    Don’t bounce, just hold.

 

30 seconds per stretch
3 x per leg
3 x per day

Enjoy the City to Surf and stay fit. Oh, and have a dip in the ocean – the icy water is good for recovery!

Karl

 

Written by Karl Lockett

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A Plantar Fasciitis update

Plantar Fasciitis in winter

Even though its cold outside and people are exercising less due the temperature and illness, the incidence of Plantar Fasciitis is still high. In fact, we are seeing more and more patients with Plantar Fascial tears. Otherwise known as deep surface tears, laminar tears or partial thickness tears. These patients are in agony and describe excruciating pain which causes them to limp and compensate for the injured foot. Some of these patients have no choice but to wear an immobilisation boot.

What’s causing this Plantar Fasciitis?

As discussed in our previous articles about Plantar Fasciitis, and its causes, the aggressive cases and the incidence of torn Plantar Fascia often come on due to a sudden increase in exercise over a short period of time. The change is too much for the foot to cope with and the strength in the foot just isn’t there. This overloads the Plantar Fascia and leads to torn fascia or aggressive Plantar Fasciitis. Heel pain comes out of nowhere, overnight, and patient’s wake up in agony and can barely walk when they get out of bed. Patient’s visit their doctor and have an X-ray taken of their foot which doesn’t help as it often comes back clear. Even with a Heel Spur on the X-ray, this doesn’t help as there is no treatment plan that follows. Remember, Heel Spurs don’t cause pain, Plantar Fasciitis does.

Patients are poorly advised

We are still seeing patients who have tried a cortisone injection as a first line of treatment. The cortisone can kill the pain and draw you into a false sense of security, meaning a return to exercise, which further aggravates the Plantar Fascia. Once the injection wears off, the heel pain is back with a vengeance. I saw a patient yesterday at the Parramatta clinic who was perhaps in the most pain I had ever seen. She had been given an ultra sound guided injection of cortisone in November which reduced the pain, but she was told to do foot stretches. 100 reps per day! This excessive load on the Plantar Fascia has more than likely caused it to tear. Her Heel Pain was extremely high. The very slightest of finger pressure, without me even pushing against the heel, caused this lady to withdraw her foot and jump as she lay on the bed. This situation supports the theory that the Plantar Fascia can not be stretched. Muscles and tendons can be, but not fascia. Fascia is like gristle. The stretch just causes strain, and the plantar fascia pulls away from the heel and gets more inflamed. Hence Plantar Fasciitis gets worse. This particular lady responded beautifully to the immobilisation boot and walked out smiling, as she was pain free. I will review her in 4 weeks and talk about how to wean her off the boot. When she is able to walk normally without hobbling, I will be able to assess her foot function and find out what caused her Plantar Fasciitis.

Regular Plantar Fasciitis

Of course, we are still seeing regular Plantar Fasciitis, which is less painful although still very sore, and usually more chronic. The heel pain has come on more gradually over a longer period of time and is not quite as aggressive as torn fascia. Treatment for regular Plantar Fasciitis is different to the above approach and patients will make a full recovery with the alternative therapies that we have.

A final word until next time

Wrap up warm and maintain your usual exercise regime. Taking a break from your usual programme might cause problems if you jump straight back in, without taking it slowly. Wear proper sports shoes and always stretch your calves.

 

Written by Karl Lockett

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Plantar Fasciitis – an overview of Karl Lockett, Sports Podiatrist

Karl Lockett is a Sports Podiatrist with a special interest in heel pain and Plantar Fasciitis. He graduated from the university of Salford, Manchester in 1998 and has been in biomechanics and Plantar Fasciitis in Australia since 2001.

Karl Locket was invited to speak at the Sports Medicine Australia seminar rooms in 2012 where he shared his knowledge with fellow Podiatrists. He regularly welcomes students from the University of Western Sydney into the clinic so don’t be surprised if there are 2 sets of hands on your feet during your consultation.

Karl currently offers treatment for Plantar Fasciitis in 4 locations throughout Sydney – Martin Place, Crows Nest, West Ryde and Parramatta. Patients with Plantar Fasciitis or other types of heel pain are often required to come to the practice once or twice so that Karl can implement a treatment plan, unless they need shock wave therapy, in which case they may come once a week for up to 6 or 8 weeks.

At the Sydney Heel Pain Clinics, Karl has different treatment options for Plantar Fasciitis, depending on the patient’s set of individual circumstances. There are some treatments that can provide immediate relief from heel pain at the first visit, such as an immobilisation boot or shock wave therapy. Other treatment examples for Plantar Fasciitis are strapping or orthotics.

The crucial part of the treatment plan however, is the advice that is given at the time of consultation. Karl provides each patient with a set of information sheets that educate the individual – this lists the do’s and the dont’s and ensures that the heel pain patient can avoid things that stress the Plantar Fascia, and delay healing of their Plantar Fasciitis. There is also a list of things that help the healing of Plantar Fasciitis including very specific stretch techniques and individual footwear advice.

Karl believes there is more than once cause of Plantar Fasciitis but that there are definite trends. It is usually possible for him to identify the exact cause of the patient’s heel pain, although its not always necessary. The treatment plan for Plantar Fasciitis is the most important thing.

Karl and his colleagues regularly attend sports medicine seminars in order to stay up to speed with podiatry research. This ensures that you, the patient, will always receive an accurate diagnosis and a reliable treatment programme. The technology used in the clinic is the most up to date and as modern as can be found anywhere. The digital foot scan equipment is accurate to 0.1mm which removes any margin of error when taking a digital foot scan or designing orthotics.

Plantar Fasciitis can be a very stubborn form of heel pain and requires very specific treatment. At Sydney Heel Pain Clinic, Karl Lockett and his colleagues consistently achieve results which remove heel pain and allow patients to make a complete recovery.

If you would like more information about Plantar Fasciitis or other types of heel pain then you can read through the other articles on this website or you can to speak to the practice manager.

 

Written by Karl Lockett

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Plantar Fasciitis or Heel Spur

This article has been written to clear up the confusion that surrounds two of the possible causes of pain underneath the heel. Patients and practitioners alike seem to be using 2 different terminologies (Plantar Fasciitis or Heel Spur) to describe the same condition when in fact a Heel Spurs and Plantar Fasciitis are very different ailments.

So what causes heel pain, the Heel Spur or Plantar Fasciitis?

There is a common misconception that pain in the heel is caused by a Heel Spur when in fact it isusually caused by inflammation of the plantar fascia – Plantar Fasciitis. Heel Spurs can be present on the foot without there being any pain at all.

An example of a common heel pain situation follows:

A patient arrives at the Podiatry clinic and hands over an X-ray of the Left foot and an X-ray of the Right foot. The X-ray clearly shows a Heel Spur on both feet. The Heel Spurs look like small spikes coming away from the bone, shaped like small rose thorns. Further into the consultation the patient reveals that they have heel pain in only one foot, not both. It is fair to say then, that in this situation, that the Heel Spurs are not causing the heel pain, but that something else is. Typically, that something else is Plantar Fasciitis. Surely, if the Heel Spurs were the cause of heel pain in this patient then he or she would be experiencing pain in both heels.

Why the confusion?

It has been extremely common place for quite some time, that a large percentage of patients suffering with heel pain will visit their local GP before visiting anyone else. For many years, the common approach to these types of foot problems by a GP is a referral for X-ray. Understandably, these spikey bits of bone on the heel, that stand out like a sore thumb on the X-ray were, and sometimes are, still focused on by the GP and the patient. Heel Spurs look so out of place that it’s easy for the patient to accept that this spikey piece of Heel Spur is causing their pain. However, with the above information in mind it is safe to say that the Heel Spur isn’t the cause of pain, as they can be seen on X-rays of a pain free foot!

So what does cause pain?

Plantar Fasciitis causes pain. Of this there is no doubt. Plantar Fasciitis usually causes inflammation at the site of the Heel Spur, hence the confusion for patients and some practitioners. When we poke around at the site of the Hel Spur, we are prodding and pushing against an area of inflamed plantar fascia. When a patient reports pain from a Heel Spur they are really describing Plantar Fasciitis.

Why is it necessary to differentiate between a Heel Spur and Plantar Fasciitis.

An accurate diagnosis and a better understanding of the problem at hand will lead to the most appropriate treatment plan. The treatment plan that one would use for a Heel Spur would not necessarily help relieve Plantar Fasciitis, and vice versa. Most patients who misunderstand this concept will usually try to use soft shoes and soft pads inside their footwear in an attempt to cushion the Heel Spur. However, soft materials and cushioning create instability, and instability leads to further strain on the plantar fascia, which aggravates the condition. Therefore, correct treatment of Plantar Fasciitis should be to relieve strain on the plantar fascia with more supportive shoes and stronger materials as opposed to tying to cushion the heel with softer ones.

Summary

To conclude, it is important to understand that a Heel Spur does not cause pain, but rather the inflammation of the plantar fascia surrounding the Heel Spur. This really indicates that Plantar Fasciitis causes heel pain and not the Heel Spur itself. Therefore, we must treat the Plantar Fasciitis and focus less on the Heel Spur. Learn about the treatment here: Plantar Fasciitis Treatment

NB: This article refers to plantar heel spurs underneath the heel and not posterior heel spurs at the back.

 

Written by Karl Lockett

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Plantar Fasciitis in Runners

1: Too much too soon

It is not uncommon to find Plantar Fasciitis in runners who have increased the intensity of their training programme too quickly. There should always be a gradual increase in the number of days training per week and likewise, a gradual increase in the distance of each run. Failure to follow this general rule can lead to Plantar Fasciitis in runners as well as other foot and leg injuries.

2: Hill training

We commonly see Plantar Fasciitis in runners who have been training on hills or inclines. Hill training loads the foot more than running on a level surface. This increase in strain can lead to Achilles tendon issues, calf tears or Plantar Fasciitis in runners.

3: Boot camp

The explosive nature of some of the programmes in boot camp follows a definite trend in the onset of Plantar Fasciitis. Ballistic movements such as jumping, sprinting and skipping can add significant load to the foot. So while Plantar Fasciitis in runners is common, it also affects the recreational athlete in boot camp or body attack type classes too.

4: Tight calf muscles

Plantar Fasciitis in runners with tight calf muscles is extremely common. Running is a movement that loads the calf muscles and it is essential that this lower leg muscle group be stretched after each run. Performing short calf stretches before the run and longer stretches after the run is advised, and this can help to reduce the chances of Plantar Fasciitis in runners.

5: Running shoes

Unsuitable running shoes can lead to Plantar Fasciitis in runners. Running shoe suitability is a very specific science these days as the technology in the shoes continues to evolve. A person’s body weight, foot shape, running style, or foot type will determine which make and model of running shoe would be most suitable. Failure to use a suitable running shoe can not only lead to Plantar Fasciitis in runners but other conditions too, such as tendonitis or stress fractures.

6: Forefoot striking

Running style is a contentious topic, and what works well for one person might not necessarily work well for another. (Body weight, stride length and cadence are but a few of the relevant factors that can make a difference). That said, there is an argument that forefoot loading adds extra strain to the foot and calf muscles. It is not uncommon to come across Plantar Fasciitis in runners with this particular running style. Some Sports Podiatrists will argue that it is the tightening of the calf muscles in patients with this running style that causes extra pulling on the heel and hence leads to Plantar Fasciitis in runners, while others will support the fact that there is simply an overload of pressure with each foot strike, which creates the pulling of the Plantar Fascia on the heel. While it is known that Plantar Fasciitis in runners occurs with other running styles, we can not ignore the fact that it occurs commonly in the forefoot striker.

7: Other sports

While Plantar Fasciitis in runners is common, it occurs in other sports too. As discussed above, boot camp has its fair share of victims, as does the Golf course, due to its undulating surfaces and the shear length of time that the participants spend walking them. Tennis produces patients with Plantar Fasciitis, as does the world of soccer and basketball. As a general trend, Plantar Fasciitis in runners occurs due to the same factors as those seen in these other sports – foot strain and tight calf muscles.

You might also want to learn about the following:

Plantar Fasciitis Treatment
Plantar Fasciitis Recovery Time

Or watch the video to learn more: Plantar Fasciitis Video

 

Written by Karl Lockett

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Plantar Fasciitis Recovery Time

What is the approximate Plantar Fasciitis recovery time?

The recovery time for Plantar Fasciitis is varied and is dependent upon different factors. In general it can vary from a few days (if treatment starts early) to a few years if left untreated. If the wrong treatments are implemented and the Plantar Fasciitis is aggravated then the heel pain can last for years. Problems such as Plantar Fasciitis, and most inflammatory foot conditions are often ongoing due to the simple fact that we cannot rest our feet, as we can other parts of our body such as a hand or an arm. Even if we refrain from physical exercise, or take time off work, there is still stress and load on our feet as we walk and so Plantar Fasciitis recovery time can be months rather than weeks.

Plantar Fasciitis recovery time will depend on the following factors:

  • The length of time that the patient has been feeling heel pain has a bearing on plantar fasciitis recovery time. Patients who present to the clinic soon after feeling the symptoms of Plantar Fasciitis can often recover within a week or two.
  • In such cases we will implement quick and simple remedies and encourage rest and an emphasis on footwear.
  • The severity of the damage to the Plantar Fascia will also affect Plantar Fasciitis recovery time. This can be measured by ultra sound imaging. The greater the damage to the Plantar Fascia, then the greater the inflammation, and hence the longer it can take to fully recover.
  • The presence of a tear in the Plantar Fascia can also affect Plantar Fasciitis recovery time. Naturally, a tear takes longer to heal. The treatment for a tear usually involves a rehabilitation boot and these have been found to reduce Plantar Fasciitis recovery time dramatically. Treatment duration can be reduced to 6-12 weeks depending on the severity of the Plantar Fascial tear.
  • The use of prescription orthotics (if designed well and if comfortable) will reduce Plantar Fasciitis recovery time significantly. Patients who follow instruction and wear their orthotics daily will usually have a Plantar Fasciitis recovery time of around 6 weeks.
  • Occupation is a significant factor in Plantar Fasciitis recovery time. Patients with weight bearing jobs who are on their feet for long periods will sometimes take longer to heal than those with less strenuous jobs. These patients might have a Plantar Fasciitis recovery time of 8-12 weeks rather than 6 weeks.They will need monitoring throughout the course of their treatment. Such patients are Nurses, School teachers, Rangers, Builders, Personal trainers, Hairdressers and more.
  • Body weight can affect Plantar Fasciitis recovery time. Heavier patients have more stress on their feet and for this reason they can take longer to heal. For heavier patients who have Plantar Fasciitis but no tears in their plantar fascia it may take 12 weeks as opposed to 6 weeks to recover. The irony lies in the inability to exercise in order to lose weight due to the pain in the heel.
  • Footwear is crucial when trying to reduce Plantar Fasciitis recovery time. Supportive shoes are a must!

Patients with stronger and more durable shoes will have a shorter Plantar Fasciitis recovery time than those patients wearing softer and less supportive footwear. It is important to have professional advice regarding footwear. A patient’s idea of a “good shoe” is often very different to that of a podiatrist.

Ultimately, Plantar Fasciitis recovery time is significantly reduced when professional care and treatment from an experienced heel pain practitioner is put in place. An average recovery time of 6-12 weeks is common, taking into account the above information.

To know about the treatment for plantar fasciitis, see here: Plantar Fasciitis Treatment

 

Written by Karl Lockett

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Plantar Fasciitis Symptoms & Causes Video

Video about Plantar Fasciitis Symptoms and Causes by Karl Lockett

 

Transcription Below If You’d Rather Read:

Hi! I’m Karl Lockett. I’ve been a sports podiatrist for twelve years,and I’ve found that one of the biggest causes of heel pain is recreational running and walking. The most common symptoms of plantar fasciitis are pain around this part of the heel here, or through the arch of the foot here. Many Patients report the feeling of stone bruise, or a pebble in the shoe. When they wake up in the morning and they put their foot on the ground, there’s often a lot of pain. Most patients hobble for the first few steps, and after a few minutes, the pain tends to drop off. In the first consultation, we try and work out why they’ve got the problem,have a good look at their foot function, have a look at what shoes they’re using, put them on a treadmill, video their feet, see how they walk, and then we’ll give them some feedback on the things that they can do to avoid the problem, and things that they can do to reduce the pain, and moving forward, things that they can do to support the fascia and enable the healing to take place.

Some people have inflammation in the fascia. Other people have tears in the fascia. So, everyone is different, and for that reason different people will respond to different treatments. Some people benefit from orthotics, some people benefit from simple stretching techniques and footwear advice. Other people might need to go into a rehabboot. It really depends on how severe the problem is, and how accurately your problem’s been diagnosed. So if you’ve got foot problems, if you’ve got any type of heel pain, if you got symptoms consistent with plantar fasciitis, I can help. (end of transcription)

To know more about the treatments, click here: Plantar Fasciitis Treatment. Or you may watch the video: Plantar Fasciitis Treatment Video

 

Written by Karl Lockett

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Plantar Fasciitis Exercises

Plantar Fasciitis Exercises

Plantar Fasciitis Exercises are common, but are they beneficial?

Most new patients that arrive at our clinic are performing Plantar Fasciitis Exercises but are not sure if they are doing the right thing.

They ask, should I be doing Plantar Fasciitis Exercises, because my heel pain doesn’t seem to be improving?

In general, the answer is no!

The Plantar Fascia, once inflamed needs to rest. If the Plantar Fascia can rest, then it can recover. The majority of new patients coming to out clinic are performing Plantar Fasciitis Exercises that are aggravating the condition.

Plantar Fasciitis doesn’t come about due to a weakness of the foot muscles or a weakness of the fascia, so doing exercises to strengthen the foot is not beneficial.

Loading the foot with extra body weight or force during a strengthening exercise can cause pulling of the fascia on the heel, and this can prolong the Plantar Fasciitis.

There are a variety of Plantar Fasciitis exercises that are common:

  •  The step stretch. Hanging the heel off the back of a step or kerb.
  •  Pulling the toes back. Using your hands or a towel.
  •  Heel raises. These put a lot of stress on the foot and can really aggravate Plantar Fasciitis.
  •  Pushing the toes against a wall.

Performing these Plantar Fasciitis Exercises can sometimes give short-term relief and hence hope to patients. Due to this short-term relief, patients continue doing the exercises. It becomes habitual, and almost instinctive. Patients perform these stretches without even thinking about it sometimes. They instinctively hand their heel off a step when they are on the escalator, or without thinking about it will grab hold of their toes and pull backwards, whilst watching television.

It’s only after months of heel pain from Plantar Fasciitis that they realise something they are doing is wrong. They eventually work out that the Plantar Fasciitis Exercises may be prolonging their Heel Pain.

Why are so many people performing Plantar Fasciitis Exercises?

The problem is that everybody has access to the World Wide Web these days and there are so many websites that recommend these stretches. Furthermore, most G.P’s have limited knowledge when it comes to the treatment of Plantar Fasciitis, Heel Spurs and Heel Pain.

Plantar Fasciitis Treatment

The treatment of Plantar Fasciitis is much more complex than just Plantar Fasciitis Exercises.

There are many factors to consider such as the different causes of the condition, which vary from patient to patient. The individual cause must first be removed before an appropriate treatment plan is put in place.

The treatment plan may include some exercises but these will be very specific calf stretches that release the heel without straining the fascia at the same time.

The relevant type of support will then be installed: Shoes, boots, splints, footwear changes or taping. It depends which of these the patient needs.

You may also read more about Plantar Fasciitis Treatment.

Factors that accelerate healing of Plantar Fasciitis.

Once the above principles have been applied it is then an option to speed up the recovery of the Plantar Fasciitis with things such as ice packs, shock wave therapy or acupuncture.

If you are performing Plantar Fasciitis Exercises and are you are still in pain then stop!

At Sydney Heel Pain Clinic we can put the correct treatment plan in place for you.

Appointments: 93883322

 

Written by Karl Lockett

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