Plantar Fasciitis aka Plantar heel pain is a tricky condition to treat and not necessarily easy to diagnose. It can be an extremely debilitating condition that increases levels of depression, anxiety and stress.
When our team of physiotherapists, chiropractors and exercise physiologists in Mt Kuring-Gai are looking at patient with suspected plantar heel pain there are a few things we want to know including:
- Your goals and expectations regarding recovery.
- Your current physical activity level.
- Previous treatments you may of tried.
- Any other history of the injury or other injuries, especially to tendons.
When we are looking at your foot what we are interested in seeing is whether there is sharp localised pain where the plantar fascia joins your heel bone and whether it's most painful first thing in the morning out of bed or aft sitting for a period of time. Some people even described it as feeling as though they have stepped on some glass!
The major risk factors for Plantar Fasciitis tend to be:
- High BM
- Flat feet (pes planus) when standing
- Thickening of plantar fascia/heel pad
- Poor running mechanics
- A previous history of plantar heel pain
- A significant change in load levels associated with the feet.
How do we treat it?
The most important thing to remember with plantar heel pain is that there is no one size fits all solution for it and it can linger in some cases for up to 12 months.
With regards to treatment approach we want to be differentiating the patient based on whether they are either recent onset vs persistent pain AND athlete vs non-athlete.
For recent onset first line treatment consists of:
- Activity modification
- Good advice about conditioning and load vs capacity
- Heel cups or soft shoes if patient needs/wants to continue to participate in specific activity
- What is there work/occupation outside of physical activity
- KEEP IT SIMPLE
For persistent pain treatment should consist of:
- Activity modification based upon the patient's aggravating factors
- Heel cups and taping of the foot
- Strategies on how to manage foot load at home and in the work place
- Heavy-slow resistance training with stretching
- Encourage self-management
- They have been shown to be better than placebo for 0 - 4 weeks but no further benefit after this point
- No difference shown between prefabricated vs customised
- Work better in combination with stretching
- Can provide short-term pain relief
- No specific technique required just ensure the arch is supported by it
If after all of this and we are finding that the foot is still not tolerable other options include corticosteroid injections (done by your medical doctor) or extra corporeal shockwave therapy (EWST) whilst the evidence isn't as well established for this we have found excellent results from it with some of our patient.