Plantar Heel Pain (a.k.a. Plantar Fasciitis)

Aetiology (What is it?)

Plantar Heel Pain (PHP) aka Plantar Fasciitis, is characterised by heel pain which usually occurs after periods of non-weight bearing (e.g. upon stepping out of bed in the morning). Pain tends to subside upon movement.

PHP is the most common cause of foot pain and accounts for 11-15% of all foot pathologies requiring professional care. There is increased incidence between the ages of 40-60yrs of age. PHP occurs in 10% of runners.

Pathophysiology (What’s happening?)

Plantar fascia is a thickened superficial band of fibrous connective tissue that originates at the heel and expands to the toes.

Although the exact cause is not certain, plantar fasciitis is thought to be an overuse injury due to excessive strain on plantar fascia leading to microtears, collagen necrosis and angiofibroblastic hyperplasia. Therefore, plantar fasciitis is not thought to be an inflammatory condition and it is suggested that it be referred to as Plantar Heel Pain (PHP).

Signs and Symptoms

Sharp pain in the heel region. The pain is most noticeable when stepping out of bed in the morning or standing up after long periods of being seated.

Risk factors

  • Pes planus (flat feet) or pes cavus (high arches)

  • Obesity

  • Pregnancy

  • Leg length discrepancy

  • Occupations that involve prolonged standing

  • Wearing unsupportive shoes such as jandals

  • Reduced ankle dorsiflexion (this could be due to a number of factors including a stiff talocrural joint; shortened and/or weak gastrocnemius/soleus (calf) muscles; tight achilles tendon

  • Runners (hard running surface, change in footwear, increased intensity or duration)

Conservative medical treatment options

  • Relative rest from the offending activity (e.g. Physio may advise to stop running for a period of time)

  • Ice massage: roll a frozen bottle of water under the affected foot. Ice relieves pain and rolling stretches plantar fascia

  • Stretches for calf muscles to relieve tension on plantar fascia

  • Plantar fascia stretch – use one hand to stretch the toes upward while using other hand to feel the stretch in the plantar fascia

  • Night dorsiflexion splints may be advised

  • Orthotics to provide arch support if required

  • Massage : Deep tissue massage and trigger point therapy to the gastrocnemius and soleus muscles to reduce tension and lengthen muscle fibres. Deep friction massage to the arch and the plantar fascia insertion in the heel may be required. Dry needling may be used in the calf muscles to reduce tension on the plantar fascia

If not responding to conservative treatment a specialist may advise:

  • Corticosteroid injection

  • Extracorporeal shockwave therapy

  • Autologous platelet rich plasma injection

  • Surgery as a last option

References

Biel, A. (2014). Trail Guide to the Body; a hands-on guide to locating muscles, bones, and more (5th ed.). Boulder: Books of Discovery.

Buchbinder, R. (2004). Plantar Fasciitis. The New England Journal of Medicine, 2159-2166.

Cornwall, M. W., & McPoil, T. G. (1999). Plantar Fasciitis: Etiology and Treatment . Journal of Orthopaedic & Sports Physical Therapy, 756-760.

Lim, A. T., How, C. H., & Tan, B. (2016). Management of plantar fasciitis in the outpatient setting. Singapore Medical Journal, 168-171.

PLANTAR FASCIITIS - a patient's guide. (2019, April 15). Retrieved from Family Doctor: https://www.familydoctor.co.nz/categories/bones-and-joints/plantar-fasciitis-a-patients-guide/

Plantar Fasciitis. (2019, March 24). Retrieved from Health Navigator New Zealand: https://www.healthnavigator.org.nz/health-a-z/p/plantar-fasciitis/

Renan-Ordine, R., Alburquerque-Sendin, F., De Souza, D. P., Cleland, J. A., & Fernandez-de-las-Penas, C. (2011). Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy, 43-50.