Heel pain and plantar fasciitis / heel spur syndrome treatment!

Symptoms:

Pain in the heel first thing in the morning

Pain on rising

These are the typical symptoms of Plantar Fasciopathy, also known as Plantar fasciitis/heel spur syndrome.

Anyone may develop plantar fasciopathy however females in their forties and runners are particularly susceptible.

Causes are varied but may include:

• Poor footwear choices

• Poor biomechanics/foot and general body posture

• Muscle weakness/ fatigue and structural overload

• Activity overloading- too much too soon FITT principles

• Trauma to the heel

Descriptions of heel pain are many and varied with some describing as a hot poker, others a dull ache and some a stone bruise. The type of pain you are experiencing may be a result of compression injury where the fascia is compressed against the heel bone as it rounds it. Some pain may be bone related with bone bruising often seen in long standing or traumatic cases of plantar fasciitis, and so will feel different.

Treatment:

Stretching will help if tight muscle,tendon or fascia is the issue. Our assessment involves looking at calf flexibility both soleal and gastrocnemius as well as the plantar fascia itself.

Strengthening of the calf is generally accepted as being helpful more long term. That is frustrating when you continually do your calf raises and plantar fascia strengthening exercises and your pain doesnt seem to improve. But keep with it as there is evidence to suggest if you do, once its gone its much less likely to come back.

Strengthening also comes in many different forms, eccentric, concentric, isometric, plyometric, and during your assessment you will be guided as to which we feel you need to work on.

Muscle recruitment is often overlooked or confused with strengthening. It may be great if you strengthen yourself to build into 25 calf raises but is the function/technique of the raise ideal. Are all the ankle stabilisers, toe flexors and extensors and both calves all working together to help out….this is important especially when looking at Core and Pelvic stability.

Core and pelvic stability are particularly important. With a background in running and running assessment we look closely at this. The muscles of the core and pelvis are not only very powerful (much more than the smaller muscles in the calf and foot) they also play a huge role in skeletal posture and support. This is crucial if you have a job that requires a lot of standing or walking and of course if you are a runner.

If you are generally sedentary, thats ok (although I would love you to get out and exercise more), but we can assume you are generally ‘weaker’. Without regular increases in cardiovascular stress, or resistance stress, any smaller change in weekly activity could result in a significant loss of posture and therefore greater stress at a foot level. This will affect your ability to heal- especially plantar fasciitis.

RICE- Rest ice compression and elevation. Initial injuries may benefit from this however rest has been shown to be detrimental in the long term. The fascia responds to being stressed (in the right way) and weakens in the abscence of stress, so following an initial rest period if the cause was an overload of the FITT its very important to keep moving. I do find keeping an ankle oedema/swelling down will assist healing and compression socks/stockings can be useful for this or we have FS6 socks available that people love.

Footwear plays a huge role in both the cause and treatment. We have a comprehensive footwear fit guide that our close network of shoe stores are aware of. We use your feedback, the look and our guidance to help find the right shoe. High arch feet and low arch or flat feet will need different things out of their footwear. Additionally the events, the surface the sport etc will all play a role in the type of footwear you are looking for.

Orthotics are very useful in a mechanical offload or support of the fascia while in the healing phase, and when FITT and footwear or playing surfaces place forces on the the foot and ankle that your mechanics or strength just cant cope with. When you injure your foot you still have to walk on it, and with complete rest not being advised orthotics can help fill the void. Short term strapping can help and are a good indicator as to whether you will benefit from orthotics.

Dont be put off by orthotics, they get a bad wrap for being ‘hard’ and ‘painful’ and ‘bulky’ and ‘they gave me blisters’ or ‘ I want to run naturally’.  The orthotics we prescribe are non bulky, lightweight and will fit into normal footwear in most cases. We promote a natural gait as much as possible using strength, posture and running/walking technique and prescription is based on individual biomechanics, activity type, load, surface type footwear etc.

Injections:

There has been much debate about plantar fasciitis and whether or not it has an inflammatory component. Cortisone injections that target inflammation (steroid) have been shown to help and some people ‘swear by it’. However, the research is varied and typically shows poor results for cortisone. There may also be some side affects but in saying that when the pain acts ‘inflammatory’ cortisone can be very useful. I would advise you exhaust the more conservative options before heading down this path, and if you do we work closely with the Sports Doctors who perform the injection.

PRP or platelet rich plasma are injections of white blood cells into the area of injury. Long standing chronic heel pain seems to benefit the most and or injuries that have involved some tearing of the fascia.

Surgery there is alot written about it, my advice is don’t even think about it! I have never had to go down this route and I dont expect that ever to change. A lot of surgeons never perform it and theres good reason for that!

Unsure what proper gait is – how to walk or run – check our blog out next week or in the mean time come and speak with us at our Podiatry Clinic in Sutherland 9521 7578 or visit the website www.southernsportspodiatry.com.au