What is Plantar Fascitis?

Plantar fasciitis is a condition also known as “Policeman’s Heel”. It is a painful condition often accompanied by pain and tenderness on the underside of the heel. It can sometimes radiate further into the sole of the foot, towards the toes. It is the most common cause of heel pain seen within practice for foot pain. The plantar fascia (PF) is a band of flat tissue found on the underside of the foot that connects the toes to the heel bone. It is a taut structure which helps maintain the arch of the foot keeping the foot in a neutral position. If the PF gets too tight or too short, it can pull at its attachment to the heel bone which causes localised pain and inflammation. This is often seen in runners who have new shoes. Very common around January with new shoes as presents and New Years resolutioners getting into running with poor footwear.

Under the sole of the foot is a natural fat pad which provides a cushion to the bony texture of the heel bone with the ground we walk on. In some types of PF, we see a significant loss in the height of the fat pad this is seen when patients lose weight and is more common in my experience in leaner individuals. Over time, the fat pad can be inflamed without protection and support from surrounding muscles which is where pain comes in.

Who is at risk from Planta Fasciitis?

There are certain groups of people who are at greater risk of developing this condition. Being overweight is a factor, due to more force being placed through the foot. Think of Newton’s Law, every action has an equal and opposite reaction. Anyone on their feet for long periods such as nurses or waiters, especially those with either poor or new footwear. Another common person is someone who does long-distance running (runners are notorious for not resting and pushing through pain, especially with shoes that have not been fit properly). 

How to manage Plantar Fasciitis

1. Rest. Rest from the aggravating activity will give the foot time to recover from the injury. Often the hardest to do for most people as we are on our feet most of the day. It is best to reduce running or walking on hard surfaces temporarily. I would suggest you only restart running once you can walk 5km without pain.
2. Heel Cushions/Orthotics. To almost re-create the degraded fat pad, you can buy a heel cushion/orthotic, usually gel-based and place it under your heel, which can sometimes be very helpful. If you choose to do this, as chiropractors, we would suggest you buy one for each foot, irrespective if the pain is on one side or both sides, to avoid causing other misalignments in your spine which would mean more work for us and more pain for yourself. Something we want to try and avoid.
3. Footwear. Invest in a decent pair of shoes that can help provide enough support to your foot. Every person is different and I would recommend being fitted for appropriate footwear. I recommend having your gait analysed and I personally send my patients to Run Company in Woking.
4. Ice. Try icing the sole of the foot to reduce the inflammation. An easy home-made tool is to freeze a bottle of water and use it as a rolling pin on the sole of the foot. Gently massage the tender spots on the heel bone for about 5 minutes twice a day using a soft item first such as a tennis ball and when able to deal with more pressure and pain tolerance increase to a firmer ball such as cricket, hockey or golf ball.
5. Stretches. Stretching the calf muscles and gently massaging the sole of the foot with a golf ball can be helpful to reduce tension on the plantar fascia muscle from both ends.
6. Lose Weight, if necessary. Losing weight can be useful to reduce the impact on the soles of the foot. It is often the most neglected element however previous patients who have employed this protocol have responded with positive reviews on the condition improving.
7. Manual Treatment. Certain soft tissue techniques, manipulation and acupuncture can be very effective for stubborn cases of this condition. In clinic I use these techniques often to treat this condition.
8. Gait Analysis and Possible Orthotics. If further problems persist then it would be beneficial to speak to a biomechanical podiatrist who will perform a detailed gait analysis to assess the movement of your feet and legs. If necessary, they may prescribe tailor made orthotics or shoe inserts to help correct any dysfunctions they find. Although these tend to be more expensive, the cost of relief is worth every penny for the disability this condition can give.
9. Shockwave and or Laser Therapy. These have become an increasingly popular way of managing long term plantar fasciitis. If other avenues have failed, it may be worth pursuing a practice that offers these services. The research is very clear on this condition and that no more than 6 sessions should be attempted in order to receive positive benefits.
10. Steroid Injections. For cases where the PF has become deformed or severely damaged over time, steroid injections may be the only option. This is a last case resort scenario and one you should discuss with your GP if you have tried all other avenues of care without much success. 

If you would like further advice, or a chat I would be happy to advise – call 07442714526 OR book now.