Plantar Fasciitis - Heel Pain from Hell

Plantar Fasciitis - Heel Pain from Hell

The term plantar fasciitis is used in medical terminology to describe pain in the heel region on the bottom of your foot. It is a hugely controversial topic amongst health practitioners and debate rages as to whether it has anything to do with inflammation and hence the "iitis", which denotes the presence of inflammatory cells perhaps should not even be used?

The term plantar heel pain is far more well rounded (just like your heel bone..) and we tend to use that in our clinic. The treatments for this condition are hugely variable and include everything from stretching, to cortisone injections, to shockwave therapy, acupuncture and wearing specially designed socks. The research into effective treatments reveals mixed success and in my experience whenever interventions do not show a large treatment effect size, it usually means we don't fully understand the cause.

Plantar heel pain can have a wide variety of causes. From poor fitting footwear, to age related changes to the fascia, to metabolic conditions (like diabetes) and the list goes one.

In my clinical experience I have found the best way to fix plantar heel pain is to attempt to classify it into a sub category or sometimes multiple sub-categories. We can then look at other research that has greater treatment effectiveness and apply similar approaches. Let me give you some examples:

PHP usually (not always) falls into one of the following categories:

1.  Tendon like behaviour

2.  Biomechanical influenced

3.  Tightness/soft tissue restriction

4.  Neural/nerve related

5.  Other structure

In this way we can apply different interventions and test for responsiveness.

For the list above, try these interventions and as always- seek professional medical advice.

1. Tendons respond well to load management and strengthening. So consider cutting back your activity and strengthen the calf, hamstring and foot muscles.

2. A purely biomechanical issue should respond well to a taping or orthotic strategy. Try taping the foot using a low dye method (Google for a video) and see if the pain changes or responds. If yes, consider using some orthoses and seek a professional Podiatry or Physio opinion.

3. If the plantar fascia is tight, simply stretching the foot and calf should see an improvement. The Strassbourg Sock is a wonderful way of stretching overnight too. Try stretching your calf muscles for 60 seconds x 2, 3  x day.

4. Any signs of tingling, burning or other more nerve type related symptoms requires a slightly different approach. Gentle massage of the arch muscles is helpful and exploration further up the leg, along the nerve pathway is indicated. Even right up to the back. Has the back been stiff lately? Start using a massage ball to mobilise and massage the arch muscles for 5 mins 2 x day.

5. Often there is another cause for the heel pain, such a stress reaction/fracture in the heel bone, a rheumatological issue or referred pain from another foot structure. If none of the above tips help - it is really important to seek help from a medical practitioner.  

Back to blog