Heel pain

Background

‘Plantar’ means sole of the foot and ‘fasciitis’ means inflammation of tissue. This is the commonest cause of heel pain in adults and is characterised by pain felt beneath the heel with walking. It is worse after periods of rest, especially first thing in the morning. The plantar fascia is a sheet of tissue on the sole of the foot which becomes damaged as it connects with the heel bone. Once damaged, it heals very slowly.

 

What causes it?

The tissue is constantly stretched as we walk and is important in maintaining the foot arch and helping with powering the foot while walking. It becomes damaged with increasing age and load placed upon it. When the rate of damage exceeds the rate of repair the tissue becomes painful. The commonest causes include being overweight, spending long periods on your feet or sports. Occasionally, no cause is obvious. There are other causes of heel pain which may require you to be referred to an orthopaedic surgeon for assessment.

It used to be thought that bone spurs arising from the heel bone were responsible for this pain. MRI scans have shown that the spurs are in the muscles of the foot and not part of the plantar fascia. Also, the presence or absence of spurs is totally unrelated to heel pain.

 

What happens with no treatment?

Even if nothing is done medically the pain will settle. It does so very slowly however. Most people (80%) are better within 6 months; 90% by 1 year and 95% by 18 months. The following treatments aim to shorten this timescale.

 

Treatment options

1. The most important point is for you to identify a cause in your lifestyle that may be contributing and correct this if possible.
2. Other simple options also include wearing cushioned shoes (e.g. trainers) and having frequent rests from long periods of standing.
3. Stretching exercises are the most beneficial (proven in studies). Pull the ankle and big toe up and massage (firmly) over the tender spot for 5-10 minutes. Do this 3-5 times per day especially before getting out of bed and after sitting for long periods.
4. Injections of steroid into the painful area can help in the short term but have not been shown to improve patients recovery overall.
5. Insoles from a podiatrist have very little benefit other than gel-filled heel cups to cushion (available at pharmacists).
6. Physiotherapy may be requested by your doctor if you have a tight calf muscle, but is not required routinely.
7. High frequency ultrasound is a newer technique, which has shown to be effective if stretching fails to help. There are no complications (apart from some minor discomfort during the treatment).
8. Surgery is very rarely performed as it is a self-limiting condition.

 

Pull the ankle and big toe up. Firmly massage the tender spot with thumb.