WHAT IS IT?
- inflammation (ITIS) of the dense fibrous sheath of the sole of the foot;
- running from the heel, crossing the ball of the foot (PLANTAR FASCIA)
WHAT DOES THE FASCIA DO?
- absorbs shock
- adapts the foot to changes in terrain
- facilitates foot push off
- tender inside bottom of heel, may have diverse discomfort over rest of heel into arch
- often one sided
- morning pain and stiffness, pain on standing after prolonged rest
- early stage: pain after activity
- middle stage: pain during activity
- late stage: pain at rest
WHAT SHOWS UP ON X-RAY?
- 20% of population has heel spurs without symptoms
- up to 75% of people with heel pain have heel spurs
WHAT CAUSES IT?
- flat feet (excessive pronation)
- high arches (excessive supination)
- leg length discrepancy
- recent impact trauma
- calf muscle shortening
- toe/foot/ankle/knee/hip/pelvis/lumbar spine/or nerve biomechanical problems
- training errors
- increase mileage
- increase in frequency
- increase in intensity
- change of footwear or terrain i.e. running up hills
WHY DOES IT HURT?
- too much flexibility in foot; too much rigidity in foot
- both result in localized inflammation at the heel that is "squeezed out" with weight bearing
- at night or rest, inflammation is absorbed into the area, pushing on sensitive nerve endings ~ first morning steps are very painful and stiff until the inflammation is squeezed out and scar tissue is stretched
- once the inflammation and scarring are present they are difficult to remove
WHAT TO DO ABOUT IT?
- establish an accurate activity history
- implement modified/active rest with non-weight bearing activities: swimming, cycling, water running
- orthotic devices (custom made by certified orthotist) for "pronators" or "supinators"
- appropriate foot wear
- mobilizing / stretching shortened structures and strengthening supportive structures as outlined by your physiotherapist
- correct training errors
- achieve healthy body weight
- ice cube massage10 minutes three times a day
RULE OF THUMB
ice decreases inflammation | heat increases inflammation
- anti-inflammatory medication
- therapeutic modalities such as ultrasound or
- interferential current
- cortisone injection (only as required)
HOW DO I PREVENT IT?
- custom made orthotics
- proper shock absorbing footwear
- stretching/mobilizing potentially restrictive structures
- appropriate strengthening
- avoid training errors
- maintain healthy body weight
WHAT ELSE CAUSES HEEL PAIN?
- local tendon pain
- referred muscle pain
- local ligament pain
- fat pad degeneration of the heel
- stress fracture of heel bone (calcaneus)
- plantar fibromatosis
- low back (lumbar) disc protrusion with pinched nerve
- systemic medical conditions: osteoporosis, rheumatoid arthritis
YOUR PHYSIOTHERAPIST CAN HELP YOU WITH THE REST…