One of the most common causes of heel pain is a condition known as plantar fasciitis (PF). Plantar fascia is a flat thick band of tissue called ligament that connects your heel bone to your toes. This ligament helps support the arch of your foot when you walk. When this ligament gets irritated and swollen, over time it can become weak and develop small tears, in this case it is referred to as plantar fasciitis. This condition will cause you to have pain in your heel and/or the bottom of your foot.
Prevalence & Risk Factors
It has been suggested that 1 in 10 people will develop plantar fasciitis during their lifetime. However, according to the literature, this condition is more common in:
- Age: Middle-aged people (40-60 years-old)
- Obesity: up to 70% of PF conditions are present in obese population, especially females
- Athletes: especially young males (more common in runners)
- Being on feet for extended periods of time
- Abnormal foot mechanics: if foot rolls inward too much when walking, having high arch or flat foot, running on hard surfaces, wearing shoes with poor foot support, improper conditioning before walking/running)
About 80% of the cases have tightness in the Achilles tendon; thick band behind the ankle that attaches your calf to the heel bone. Other contributing factors include tightness to the calf muscle and/or abnormal foot mechanics (as mentioned above). This can eventually increase tension on the plantar fascia and consequently cause swelling and small tears which can irritate the fascia over time. Although many cases of PF have no clear cause.
Signs & Symptoms
Plantar fasciitis typically develops in one foot but 30% of the cases develop in both feet. Most people with this condition complain of stabbing pain in or near by the heel when taking their first few steps when getting up in the morning or after a long period of inactivity. Pain usually eases off during the day or periods of activity but becomes more painful at the end of the day.
Your physician may suggest getting and X-ray or MRI done to rule out other conditions such as pinched nerve or stress fracture in foot/ankle. X-ray may show bone spur (extra bone growth) extended onto the heel bone surface. Although, bone spurs have been associated with PF, some people may have bone spurs and have no heel pain.
Conservative: this includes treatments such as resting, use of thermal agents (i.e. cold pack), exercise, physical therapy, night splints, orthotics, and medications prescribed by your physician.
Why choose physical therapy?
Your physical therapist can accurately evaluate your foot alignment, deviations in walking pattern, muscle and soft tissue tightness, foot/ankle range of motion, lower body strength, and balance. They can rule out other conditions that may be causing similar signs and symptoms through performing special tests and other objective measures. Based on the therapist’s evaluation, they can customize a treatment plan to help treat your condition and successfully reach your goals. They can also prescribe a home exercise program to help speed up your recovery and provide pain relief. Other treatments that can be determined by your physical therapist include:
- IASTM (a tool used for soft tissue restriction)
- Kinesio and McConnel tape (used to help support proper foot alignment)
- Manual therapy (hands-on techniques)
- Sports-specific training
- Thermal modalities (i.e. ultrasound, cold pack)
- Night splints: maybe recommended by your physician to wear overnight. It helps keep your ankle in a neutral position by passively stretching your calf muscle and plantar fascia, thus may provide pain relief.
- Orthotics: can help realign foot alignment by supporting your arch and distributing force evenly throughout the foot. They can be found over-shelf (ask your physical therapist for recommendation) or custom-made by podiatrist.
Non-Conservative: If conservative treatments were not successful, your physician may recommend the following:
- Anti-inflammatory injection: a steroid medication that is injected into the painful area to help reduce inflammation and provide pain relief. Too many injections however, can weaken your surrounding joints and make them more prone to injury.
- Surgery: maybe recommended as the last resort if symptoms persist over the course of 6-12 months and conservative management have failed, Surgery may be either open incision or endoscopic (small incision) made in plantar fascia to release it from heel bone. Even after surgery is done, you are strongly recommended to follow-up with conservative management with a physical therapist.