PLANTAR FASCITIIS HEEL PAIN

MOST POPULAR TREATMENTS FOR PLANTAR FASCIITIS

1. Shock wave therapy with strapping
2. Prescription orthotics (gentle arches) with shock wave therapy
3. Immobilisation boot
4. Footwear changes with strapping and stretching

WHAT CAUSES PLANTAR FASCIITIS HEEL PAIN?

1. Tight calf muscles can cause plantar fasciitis as the Achilles tendon pulls hard against the heel bone.
2. An increase in the number of steps per day can load the fascia which can result in P.F. As can a sharp increase in physical exercise.
3. Quick movement sports such as soccer or basketball. Cross fit and boot camp too.
4. Shoes – flat, flexible, soft “comfortable shoes” can cause heel pain if worn too frequently. Nike-free and Skechers seem to be responsible for plantar fasciitis and other types of heel pain in some patients.
5. Foot shape – patients with high arches lack support in the sole of the foot. The plantar fascia runs through this area and remains taught.
6. Biomechanical issues such as a flat foot.
7. Overstretching or stretch technique –P.F can come about during calf or foot stretches

HEEL SPURS

Heel pain is rarely a result of heel spurs. If you are sore under the base of your heel, this is usually due to P.F and the inflammatory change around the spur. We treat the root cause of plantar fascial irritation, not the heel spur, and the pain subsides within weeks. Posterior heel spurs, seen in association with Achilles tendon pathology, can cause pain in the back of the heel bone.

ACHILLES TENDONITIS / TENDINOPATHY / TENDINOSIS

These 2 conditions are similar to each other but have a few small differences. Therefore, we treat A.T in a different way to tendinopathy or tendinosis. Bursitis in this same area can also be present, and this requires a different approach too.

BURSITIS

Another common cause of heel pain is an inflamed bursa. Known as bursitis. Bursitis can occur in patients with plantar fasciitis, where the bursa sits over the plantar fascia, beneath the skin, under the heel bone. But more commonly they give pain around the back of the heel bone in the area where the Achilles tendon attaches to the back of the heel bone. Therefore, they can be seen or associated with Achilles tendonitis or insertional A.T. The bursa can be named retrocalcaneal bursitis or adventitial bursitis.

Please note: patients with plantar fasciitis can also experience pain from overlying bursitis. In this instance, we treat the bursa as well as the plantar fascia.

SEVER’S DISEASE

Sever’s Disease is common in children aged 7 – 14 years. Often, children with Sever’s experience growth spurts and are playing lots of sports. Their calf muscles can become tight and this causes mechanical load on the posterior heel and irritation of the growth plate. There are several treatment options for children with Sever’s and other types of heel pain. The podiatrist will select one or a combination of treatments based on your child’s symptoms.

MORE ABOUT PLANTAR FASCIITIS

PLANTAR FASCIITIS – AN UNWANTED CHRISTMAS GIFT!

Plantar fasciitis is such a common condition that approximately 80% of patients at Sydney Heel Pain Clinics are requesting treatment for this debilitating condition. We have a page here dedicated to case studies, which relates to authentic cases of patients that we have successfully treated. https://sydneyheelpain.com.au/case-studies/

We also find that the condition is seasonal – we have our theories. Throughout the summer (or the warmer weather) the number of new patients coming to the clinic complaining of P.F increases dramatically. January is our busiest month and it is not uncommon for us to see 50 or more cases of plantar fasciitis in one week, across all our clinics.

We believe that the average person takes time off over the Christmas holidays and consequently walks barefoot, or in thongs/sandals for up to 2 weeks. These people who develop plantar fasciitis also spend time walking on the beach or in parks. This sudden change in walking habits can be directly stressful on the feet which can lead to an overload of strain and tension on the plantar fascia – resulting in severe P.F or plantar fascial rupture. However, these changed walking habits can also cause the calf muscles to become short and tight, and this can create an increased pulling mechanism on the heel bone which can also cause plantar fasciitis.

COMFY SHOES – DID YOUR SKECHERS CAUSE YOUR PLANTAR FASCIITIS?

Your plantar fasciitis heel pain could have been caused by the overuse of your soft and comfortable shoes. If it wasn’t your Skechers, then it could have been your Nike-free as these also lack support. While these shoes are stylish and very common, they don’t suit everyone. Our belief is that these shoes should not be used as your main shoe and that the time spent using them should be reduced. While we won’t necessarily place the entire blame on your shoes, we must still bear in mind that footwear selection is part of the problem, and forms part of the rehab. We observe healing and pain relief in patients with P.F when they change their shoes. Firm shoes with more support through the entire sole of the shoe, offering more rigidity (and some cushioning inside) give great results. Not just for plantar fasciitis but for Achilles tendon issues too. Obviously, a pair of running shoes or walking shoes are ideal, but we understand that not all patients can wear these shoes on a daily basis. The podiatrists at Sydney Heel Pain Clinic will help you choose footwear and can give recommendations. We offer running shoe recommendations but also street shoes and office attire. We also have a page dedicated to shoes in our mobile phone app.

More about this age-old notion that high heels are bad for women and that flat shoes are good and nearly every single female patient with plantar fasciitis finding relief from a high heeled shoe:

When the foot sits inside a shoe with a higher heel, the arch contour of the foot rises and the length of the foot decreases (the foot gets shorter). The net effect is that there is less pulling through the plantar fascia (the sole of the foot) and hence the fascia doesn’t pull so hard against the heel anymore. This is why the pain reduces or goes away completely. This is not to say that using a high heel is part of the treatment for heel pain. Using the higher heels can cause the calf muscles to tighten, and this is not good long-term – this can cause P.F in some people. Higher heels also affect the load on the forefoot and the hips / lower back. Please note: High heels seem to reduce the symptoms temporarily, they don’t necessarily “treat” the condition

EXCRUCIATING PAIN FROM PLANTAR FASCIITIS

If the pain from your plantar fasciitis or other heel pain condition is excruciating, then you may have torn something. Soft tissue rupture is not uncommon. Physical assessment in the clinic can help and the most appropriate treatment plan can then be put in place (treatment for P.F with a tear is not the same as treatment for the condition without).

Patients with torn fascia come from all walks of life. Most people we treat are not members of a sports team and were not necessarily exercising when they tore their plantar fascia or Achilles tendon. Most people with this acute condition struggle to walk without limping and feel throbbing when they are sat still / lying down.

Ultrasound imaging is not always necessary as it doesn’t change the treatment plan, but it will confirm the difference between plantar fasciitis and plantar fascial tears. It will also tell us if there is overlying bursitis.

SYDNEY HEEL PAIN CLINIC MOBILE PHONE APP

Especially for you – the patient at Sydney Heel Pain Clinic. We designed the app for all patients suffering from plantar fasciitis, Achilles tendonitis, bursitis, or Sever’s. You will find the app in the Apple App Store or the Google Play Store. It is of course free to our heel pain patients, but you will need the password. We provide you with a password at the time of consultation.

MY PLANTAR FASCIITIS IS ONLY IN ONE FOOT – IS THIS NORMAL?

Yes. Most people with plantar fasciitis are affected in only one foot. It can of course develop in the good foot later if the person limps for long enough to avoid pushing off the bad foot. It’s a common question due to an incorrect assumption that we humans are perfectly symmetrical. We most definitely aren’t. We have a bigger foot, a longer leg, or a shorter stride on one side, and this affects the load on the foot. Hence most heel pain conditions, including plantar fasciitis and Achilles tendonitis will start in one foot only.

NOTE: If your plantar fasciitis hits you hard in both feet at the same time, and affects your arches more than your heels then this can be due to either an auto-immune disorder or hormonal changes seen in menopause.

DO I NEED ORTHOTICS FOR MY PLANTAR FASCIITIS

Not always. We have a variety of treatment options at Sydney Heel Pain Clinic and we will select one or a combination of treatments based on the severity of your condition, the length of time you have been in pain, and the physical/biomechanical findings that we observe on the day. Yes, plantar fasciitis does respond really well to orthotics as the inserts will support the foot and remove the strain on the plantar fascia itself. This allows it to heal naturally. But there are other treatments that may be more suitable. Not all orthotics are designed and made equally, regardless of the way in which your foot shape was molded or scanned.

NOTE: Let’s just say that the podiatrist becomes the “Architect” and hence the end product will be a result of his or her experience, taste, beliefs and overall approach. You might see 3 different podiatrists and end up with 3 different orthotics that look similar but work and feel different.

At Sydney Heel Pain Clinic we have been using the same lab since 2003 and we have an excellent relationship based on years of communication and them understanding our patient needs. The technicians and the senior lab staff know that we treat lots of heel pain and that so many of our patients have plantar fasciitis, and hence they follow our instructions meticulously. We rarely need to modify our orthotics or make adjustments, due to the high quality of craftsmanship.

We assure all patients that they will be 100% happy/comfortable in their orthotics if we decide that orthotic therapy is the treatment of choice. There is a 12-month warranty on all orthotics.

Written by Karl Lockett

Relevant information about plantar fasciitis heel pain:

https://www.health.harvard.edu/a_to_z/heel-pain-a-to-z

CONTACT SYDNEY HEEL PAIN

If you have plantar fasciitis or any other type of heel pain please feel free to call us on 93883322 or email us with questions at help@sydneyheelpain.com.au