Plantar Fasciitis

Your plantar fascia is a thick connective tissue that starts at the bottom and inside of your heel, and spans across your arch to help support and stabilise your foot any time you stand and walk. When this tissue becomes damaged and inflamed, this is known as plantar fasciitis. You may suspect that your heel pain is being caused by plantar fasciitis if:

• Your pain is worst in the morning, when you first set your foot down on the ground from bed
• Your pain tends to ease, or completely alleviate, as you continue to walk on it
• Your pain is felt at the bottom-centre of the heel, or towards the inside of your heel, and may radiate into your arch
• During your first few steps in the morning, it feels like you’re walking on a painful pebble 
• You experience pain later in the day when standing after having a rest
• Physical activity like running aggravates your pain

Plantar fasciitis is most often an overuse injury, which means that the foot and the fascia are excessively loaded, strained and overused to the point that the fascia is fatigued and cannot support the load, and so its tissue fibres are damaged. We often see patients whose plantar fasciitis heel pain is caused by:

• Increasing their training intensity or duration, particularly in running sports.
• Switching from wearing supportive trainers or other shoes, to wearing flat slip-ons. We see this especially in those with a flatter foot type, as well as those who wear the same pair of shoes for years to the point that their supportive features have worn out.
• Having muscle weakness, tightness or imbalances, that we often identify as part of our clinical exam. Often, we specifically notice tightness in the calf muscles that affects the way their foot moves during gait - which we can see during their gait analysis.
• Having rigid feet with restricted movement which means the feet are unable to efficiently absorb shock during gait, which increases the stress on the fascia. This is often associated with a high-arched foot type.
• General abnormalities and inefficiencies in a person’s gait pattern, which means that with every step, the plantar fascia has to work a little harder than usual. While this may seem insignificant with just one step, with 10,000 steps per day each day, it can quickly add up to cause damage and pain.
• Careers and hobbies that involve standing on your feet for prolonged periods of time - particularly in retail and hospitality workers, healthcare workers, and in parents that are often carrying their children without having their feet well supported.
• Weight gain - added weight increases the demand on the fascia with every step, adding to the stress on the tissue.

A person’s age is often another risk factor for developing plantar fasciitis, due to the natural age-related changes that can occur such as the degeneration of the fat pad beneath the heel, the reduction in tissue elasticity, and the increased likelihood of developing conditions such as arthritis and other damage.

 Is it plantar fasciitis or a heel spur?

The term heel spurs is often used interchangeably with plantar fasciitis, but they are two very different things. A heel spur is a calcium deposit at the bottom of the heel that forms a protrusion, or ‘spur’. These calcium deposits often form as a response to the stress on the plantar fascia, but they are not the cause of plantar fasciitis, and in studies they have been shown to be largely asymptomatic, often being accidentally detected in radiographs when examining an unrelated condition.

 In almost all cases of heel pain involving the plantar fascia, treating the plantar fasciitis relieves the symptoms, regardless of whether or not a heel spur is present.

There are a number of things you can do to help relieve the pain associated with your plantar fasciitis at home. You can try:

• Before getting out of bed, using a towel or something similar, loop it around the ball of your foot and stretch your forefoot gently towards you. This should feel tight, but not painful. Hold for 30 seconds, the rest. Repeat three times. This will help give your fascia a gentle stretch, to help ease the immediate stress when you stand.
• Also while in bed, move your feet and ankles to mimic writing the alphabet to help warm up your feet and joints prior to placing your entire body weight over your feet.
• Keep your feet supported in good shoes both indoors and outdoors while recovering from plantar fasciitis pain. Ideally, this will involve a good sports shoe (if you need recommendations on a new shoe that will be best for your feet, our podiatrists will gladly help and give you names and styles during your appointment).
• On the above note, avoid being in bare feet, as this is when your plantar fascia will have to work hardest
• To help optimise your recovery, opt for lower impact activities such as swimming or cycling, as opposed to higher impact activities like running. It’s very important to many of our patients’ lifestyles and personal goals to be able to stay active during their recoveries, and this is one way to help make this possible.
• If your heels feel swollen and painful, you can use ice applied through a tea towel for 15 minutes at a time to help reduce the symptoms. If this doesn’t provide enough relief, you may opt for some non-steroidal anti-inflammatory medication (NSAIDs), taken as directed on the packet.

 All of the above suggestions are designed to help give you relief from your pain, but it’s important to note that they are not designed to ‘fix’ the problem. Fixing the problem means understanding why your plantar fasciitis has developed, addressing these causes so that they don’t continue to strain and damage the fascia, and then supporting the fascia to heal and repair - the only true way to eliminate painful symptoms for good. This is why our team is trusted to care for feet affected by plantar fasciitis, and how we produce results that last.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists treat plantar fasciitis on a daily basis, and as such, utilise a range of evidence-based and proven methods combined with getting to know your goals, your lifestyle and your preferences.

Every appointment starts with a biomechanical assessment to uncover the true causes of your plantar fasciitis. Your assessment involves a physical exam, testing the range of motion at your joints and the strength in your feet and legs, and assessing your foot posture. If your plantar fasciitis pain is severe and we suspect that you have a tear in your fascia, we may refer you for medical imaging to confirm. Your treatment with us may involve:

• Strapping: by strapping the foot in a specific way, we can help keep the plantar fascia in a less-strained position while you continue to walk, helping prevent further damage and supporting the plantar fascia’s healing and repair.
• Temporary offloading/padding: by placing temporary felt padding inside of your shoes, we can help offload the painful area beneath your heel to give you relief, while supporting healing.
• Orthotics (insoles): using the measurements and results of your biomechanical exam, our podiatrists can prescribe custom foot orthotics that work to keep your fascia best supported with every step, creating an ideal environment for repair. Orthotics work for the feet in much the same way that prescription glasses work for your eyes.
• Personalised stretching and strengthening programme: for those where weak or tight muscles and tendons have contributed to the development of plantar fasciitis, we will design a tailored exercise program to help address these causes, support your recovery, and help prevent your pain from recurring in the future. We know it can be difficult to remember your exercise program, which is why we email you a video tutorial of every exercise we prescribe.
• Temporary activity modification: in some cases, we may need to make some adjustments to your regular training and activities, to best support your recovery.
• Advice on icing and anti inflammatories: during their treatment, some people will experience a flare up of their pain, particularly if they have days where they wear unsupportive shoes (like for work events), are unable to wear their orthotics, or have unexpected long days on their feet. To help for these cases, our podiatrists will provide you with our guide to using icing and anti-inflammatories to help you best manage your pain.
• Footwear recommendations: your footwear plays a vital role in supporting your recovery, housing your orthotics, keeping your feet comfortable, and preventing injury. This is why we make custom footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions.