Here at the clinic, we see plenty of patients suffering from heel pain. They almost always have a similar story:
“I have an extremely painful sensation right on the heel of my foot”
“My pain is always there in the mornings, and after I do any activity!”
“I’ve had to stop my running because I just can’t bare the pain”
“The pain seems to ease as I move but it kills me immediately after”
“If I sit at my desk for an hour or so, then get up to move I can’t walk with the pain in my heel!”
All of these complaints are those you would expect from somebody suffering from Plantar Fasciosis. You may have heard of this frustrating condition before – especially if you are a runner or work on your feet a lot.
What is the Plantar Fascia?
The Plantar Fascia is a flat band of tissue that connects your heel bone to your toes and supports the arch of your foot.
What is Plantar Fasciosis? Is it the same as Plantar Fasciitis?
Plantar Fasciosis is an overload injury of the Plantar Fascia. It is the degeneration of your Plantar Fascia. This condition has historically been called Plantar Fasciitis because it was believed that Plantar Fascia inflammation was the principal underlying cause. Plantar Fasciosis is a more accurate name for this condition because it involves degeneration of your Plantar Fascia, not inflammation.
Why me? The causes of Plantar Fasciosis
It is very common in runners due to the repeated stress being placed on the fascia – can sometimes be linked to poor running technique but more often than not the process of doing too much too soon is enough to overload the fascia. Plantar Fasciosis is very common among beginner runners who might go from doing no running at all straight into a 5km run.
This is too drastic of a change for the body to handle in such a small space of time and the plantar fascia isn’t used to this amount of stress and becomes irritated and painful.
The One Thing You Should Be Doing
Before I go into detail about all the different treatment options available that don’t work, let me tell you the ONE thing that has been proven to provide long-term relief of this frustrating condition. We need to treat this injury how we would treat a tendon injury – reintroducing load to it. Loading has to be gradual, as too much too soon can only aggravate things, I have attached a video below with some later stage exercises you can do at home to get long-term relief from your heel pain.
Common Treatment Options – What Works And What Doesn’t
Whilst steroid injections can provide symptom relief, this is usually only a short-term solution. A 2012 study published in the British Journal of Sports Medicine showed that steroid injections would give temporary relief to one out of three patients, and this relief is unlikely to last beyond 4 weeks. Steroid injections can also be dangerous – they can lead to cell death and a potential rupture of the Plantar Fascia.
Shockwave therapy has been shown to have some promising results but has failed to show any consistent benefits. It has not been proven to cure Plantar Fasciitis in the long term, and can often only provide short-term relief. There are much cheaper, more effective treatment options available.
Orthotics can sometimes help with symptom relief, and the off-the-shelf ones can be as effective as the expensive custom-made ones. Studies have shown that heel pads/gel inserts are just as effective, if not more so than expensive custom orthotics.
Studies have shown that those who stretch their Plantar Fascia and their calf muscles have a greater decrease in pain than those who don’t. However, stretching has been shown to only provide short-term relief.
Anti-inflammatory drugs have been shown to provide relief in the initial stages of the condition when there may be some inflammation present. However, we now know that this is not an inflammatory condition. After the early stages, it is an overloading condition that can cause degenerative changes to the plantar fascia, which anti-inflammatory drugs will not help as there is no inflammation.
6 Tips for Plantar Fasciosis
- Stretching: Stretching of the plantar fascia and/or calf muscles can provide some people with relief! Try to gently stretch your calf and plantar fascia twice a day and you might see some benefits.
- Gel inserts/Heel pads in your shoes: These heel pads can be bought at a relatively low cost compared to more expensive custom orthotics and have been shown to be just as effective – give it a go and see if you feel the benefits.
- Ice: Applying ice or heat to the Plantar Fascia has been effective in reducing symptoms short-term in a handful of patients but is not guaranteed to work for everyone. You could start by rolling your foot on a frozen water bottle for 10 minutes every few hours and see if it helps you. Remember to put a towel between your skin and the bottle to avoid ice burns.
- Night Socks: There is a range of night socks available – some more comfortable than others, it’s important to find the one that you find most comfortable! Night socks don’t work with everyone however, they are only effective for about 1/3 of people.
- Reducing the load on your foot: This is the most important tip we can give you. The act of adjusting your activity levels and reducing the stress on your plantar fascia can bring some decrease in symptoms – the important part then is how we load it back up.
- Load it back up: Once the pain has settled a gradual loading program has been shown to be the best way to gain long-lasting relief from this frustrating condition.
Hopefully, this blog gave you some valuable information that you can use to start returning to the activities you love!
If you have any questions or concerns at all don’t hesitate to get in contact with us here at Pain and Performance Clinic by calling us on 086 787 6358.