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Plantar Fasciitis – heel pain

April 3, 2018

Plantar Fasciitis – heel pain

Plantar fasciitis is a very painful condition of the foot, and we commonly encounter it in general practice. It is estimated that 1 in 10 of us will get it at some time in our life. Typically, those suffering present with foot pain that is agonising when they take their first steps in the morning. They describe it as a 'stone bruise' under their heel, and it makes them limp and hobble around for a few minutes until it eases off. It will worsen again after a period of rest and may be exacerbated by activity.

The plantar fascia is a ligament like structure that holds together the arch of the foot, running from the heel to the toes. It is a fibrous white band of tissue, that acts as a shock absorber when we walk. In the past we used to think that plantar fasciitis was caused by inflammation of the plantar fascia, however it is now believed that it is caused by recurrent trauma causing multiple micro tears, impeding its structure and function.

This type of foot pain can be found in both athletes and couch potatoes. 10% of those who run regularly or participate in sports that involve running (e.g. soccer) develop it, but 70% of those who have it are overweight. It is a multi-factorial issue, with high arches, tight Achilles tendons, flat feet, standing for prolonged periods all being risk factors. From a mechanical point of view, those whose forefeet pronate (turns out, so during walking the big toe takes the majority of the impact and the little toe takes very little), those with varus knees (knock knees), those with leg length discrepancies and those with a high arch are all more likely to get plantar fasciitis.

Mostly, plantar fasciitis can be diagnosed from the history alone. X-rays and ultra sounds are only done if the pain is atypical or does not respond to the management plan.

Resolving plantar fasciitis can take time and much effort. It is very easy to re trigger (for example, a bare foot walk along the beach), and resolution often requires many approaches.