Unraveling Heel Pain: Comprehensive Introductions to Plantar Fasciitis

The experience of persistent heel pain can often stretch into a protracted and debilitating period of recovery, one that proves incredibly exasperating. As we navigate through this blog, we'll explore plantar fasciitis, outline various rehabilitation and exercise protocols, and discuss assistive modalities to aid your recovery, restore your comfort, and help you regain your mobility.

Demystifying Plantar Fasciitis

The plantar fascial band is a type of connective tissue. It originates at the heel, spans the bottom of the foot and inserts at the base of the toes. It covers the entire underside of the foot, providing support and upholding the structure of the arch. It's crucial to know that although the plantar fascia closely mirrors a ligament, it doesn't squarely fit into that category, as the fascia is a structurally separate tissue. 

Interestingly, plantar fasciitis is a colloquial term. The suffix 'itis' indicates inflammation as the primary cause. Research, however, has established that inflammation is not the primary cause of the condition. Consequently, the medical community has shifted towards the term plantar fasciosis, defining an overuse condition that involves thickening and degeneration of the fascia. For this article, we'll employ the more commonly recognised term, fasciitis.

Plantar fasciitis can create substantial discomfort and pain, with the first few steps in the morning or after periods of inactivity often the worst. The pain may "warm up" and reduce with activity, but flares again after a period of rest. If neglected, plantar fasciitis can deteriorate rapidly, transforming into a chronic issue that may result in partial tears requiring extensive rehabilitation. Nonetheless, with the correct care and treatment, a full recovery is achievable for most people.

Identifying Causes and Risk Factors

Plantar fasciitis often arises due to repetitive strain and excessive load during physical activity. Various risk factors can increase the probability of developing the condition. These include weak intrinsic foot muscles, unstable pronation and midfoot (arch) collapse, and a sudden escalation in physical activity. Examples include starting a new exercise routine, increasing your running distance, or training for a sport without progressively and preemptively enhancing your strength and conditioning.

Additional biomechanical factors contributing to plantar fasciitis include:

• Deficiency in calf strength and stretch length
• Limited ankle joint range of motion
• Insufficient strength in the proximal muscles at the knee and hip

It's critical to acknowledge that heel pain while walking may not always stem from plantar fasciitis. Other conditions, including stress fractures, Baxter's nerve entrapment, fat pad syndrome, tendinopathy, and neurodynamic tension, among others, could present similar symptoms. Therefore, a proper diagnosis by a healthcare professional is critical for effective treatment.

Symptoms and Diagnosis

Patients typically describe their pain as a sharp, jabbing or a profound bruised sensation at the underside of the heel. Other symptoms may include burning sensations in the area, which may indicate a nerve-related differential diagnosis. The discomfort generally intensifies in the morning, but can persist throughout the day. It's worth noting that the pain experience can vary from person to person.

Plantar fasciitis is typically a clinical diagnosis based on the patient's risk factors and a biomechanical assessment that incorporates gait analysis, range of motion, and strength evaluations. Diagnostic imaging, such as ultrasound or MRI, is usually warranted if symptoms are atypical or if the patient doesn't respond to initial treatment.

Exploring Treatment Options

The treatment landscape for plantar fasciitis is diverse and evolving. Podiatry and physiotherapy are the professions best equipped to manage this condition. 

Podiatrists conduct a comprehensive biomechanical assessment, which entails a thorough gait assessment, a range of motion examination of the foot, ankle, and lower leg and a strength examination of the foot and lower leg muscles. A treatment plan is then tailored to improve any insufficiencies found. Treatment options include strength and range of motion exercises for the foot and calf muscles, balance exercises, footwear recommendations, custom orthotics and shockwave therapy. 

In conjunction, physiotherapists assess strength and conditioning at the knee, hip and back. They supplement podiatry treatment through an exercise program of their own, soft tissue massage, trigger point therapy or dry needling (on the calf or plantar fascia itself), taping, and other modalities.

Assistive modalities can then be instrumental in managing pain during the early stages of the pathology; examples include heel raises, compression socks, and orthopedic braces. 'The Severs Sleeve' is an orthopaedic brace that, when worn in conjunction with the aforementioned treatment plans, helps reduce the stress exerted on the fascia, enabling the body to prioritise the healing phase and expedite your recovery.

If you're enduring plantar heel pain, it's essential to seek professional treatment and advice. Don't endure the pain until it becomes insufferable – the sooner you initiate treatment, the quicker you can regain your mobility!

From Pain to Performance 

The Orthopaedic Sleeve Society (TOSS)