Heel pain is a common problem affecting 10% of the population. Unfortunately contrary to a lot of advice it does not spontaneously resolve without appropriate treatment and is the most common complaint I see. It is important to make an accurate diagnosis so that treatment can be planned and given. Not all heel pain is plantar fasciitis and often heel pain may be due to problems in the ankle or even the back.
Because there are several potential causes, it is important to have heel pain properly diagnosed. The basis of any diagnosis is taking a good medical history and I will want to know how the pain started and how long you have had it for. There are a variety of diagnostic tests and imaging I can use to make and accurate diagnosis and provide you with the best treatment to resolve your pain.
What Is Plantar Fasciitis?
Plantar fasciitis is degeneration of the band of tissue (the plantar fascia) that extends from the heel to the toes. The fascia, which acts like a rope holding the foot together, first becomes stretched, leading to degeneration and then inflammation, resulting in heel pain.
Plantar Fasciitis affects 10% of the population. It is associated with a tight calf muscle but it can affect anyone. A standing job, running and obesity are all said to be risk factors but any condition that affects 1 in 10 will have a wide variety of people affected.
The symptoms of plantar fasciitis are:
- Pain on the bottom of the heel
- Pain that is usually worse first thing in the morning or after sitting for some time.
- Pain that slowly gets worse over a period of months.
There are many treatments available and we often combine them,
- Stretching exercises. Is the mainstay of treatment for plantar fasciitis. Mr Livingstone will advice exactly how to do the stretches as it is important these are done correctly, some of these stretches are on my website.
- Strapping. Strapping helps support the foot and reduce strain on the fascia.
- Orthotics. Orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. They also add shock absorption and improve function.
- Injection therapy. I do not believe in unguided injections, but will often refer for an Ultrasound guided injection. When we do this we often will decompress the area, by dry needling to stimulate healing.
- Night splints. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
- ESWT. Extra corporeal shock wave therapy is useful in long standing plantar fasciitis, shockwave about this.