Heel Pain - Plantar Fasciitis

Heel pain or pain on the bottom of the foot is usually Plantar Fasciitis

This refers to inflammation of the firm band of tissue on the sole of the foot, but is usually felt as heel pain.  

It is a common overuse injury in sportspeople, particularly those who do a lot of running or jumping but can also affect non-sports people too. We see it in ladies and men of late middle ages, in people after a period of time off their feet from injury. Other factors that contribute to Plantar Fasciitis include a recent increase in training volume, change in training surfaces or footwear, biomechanical problems and calf muscle tightness.

Repetitive use of the fascia (the stiff fibrous tissue on the sole of the foot) leads to tiny little tears in all of us. Usually, the body heals up this daily damage while we rest and sleep. In this condition, though sport, unaccustomed use, or bad sleep, this damage accumulates faster than it can be repaired and chronic inflammation results. Chronic inflammation means your body has given up healing and just tried to persuade you to stop the damage by giving you pain signals! 

You will feel pain at the back of the heel on the sole of the foot, it usually starts gradually and may initially only be painful after exercise (often the following morning). As the condition gets worse the symptoms become more intrusive and may start to interfere with sport and cause pain with day to day activities. It is often terrible for the first few steps of the day or after sitting. This is because when you rest the plantar fascia band tightens up, then the first few steps you take you are tearing it again!

If you think you have this condition it is well worth getting it checked out by Mr Willis-Owen. It can be really miserable, and if it is not treated properly it will go on for year and years.  In the meantime you should avoid any aggravating activities which may prolong the problem. It generally won't get better on its own. The first thing to do is to reduce the problem activities, and start a concerted program of calf stretching exercises. Anti-inflammatories and ice are helpful after exercise, but don't use tablets to mask the damage you are doing, of the problem will get out of control. 

Charles has had this himself and not only got better from it but ended up faster and stronger. 

Treatment involves first confirming the diagnosis then establishing the cause. X-rays or an ultrasound scan can be useful to exclude other problems and confirm the diagnosis. 

Charles recommends three levels of treatment; 

1) Specific physiotherapy, orthotics, and relative rest. The exercises you need to do are Morning stretches, grasping the ball of the foot and stretching out the plantar fascia for at least five minutes before your foot touches the ground in the morning. These are really powerful but almost no-one can be bothered to do them properly. Charles suggests setting two alarms, one five minutes before your usual wake up time, to give you time the do these and not cheating! The other exercise is calf stretching, again for five full minutes a day, timed! The devices (orthotics) that can help are the Strassburg Sock worn at night loosely just enough to stop the foot going into a tiptoe position, and gel heel pads, for some relief. The sock stops the band tightening up in the night so that when you first walk in the morning the tearing is less. The final thing to do is to get your sleep sorted out. We simply don't thee the condition in people who get eight good hours of sleep and 2 hours of deep sleep a night. Charles is very interested in sleep and its effect on disease. Have a look in his blog about this. 

 2) More recently shockwave therapy has been shown to be very promising for treating this condition. This is a really exciting new non surgical treatment that gets your body to heal itself. It is no where near as painful as injections or surgery and is covered by most insurers and available to self funding patients. In Charles' hands when the diagnosis has been confirmed the success rate so far has been 100%. Click here to learn more: Shockwave.

3) Surgery is the last resort but is not something to be terrified of. The old fashioned method of open surgery was bad, but after a year in Australia, Charles has learned, then refined a keyhole way of doing the operation which takes about 10 minutes has a two-week recovery, a good safety record and excellent results. It is still only to be used when all else has failed! This is called Endoscopic Plantar Fascia Release

Once you are recovered it is important to address any biomechanical problems, or other underlying factors in order to prevent a recurrence, get your sleep hygiene under control and address your bodyweight if needed. 

If you want to get fixed fast the sensible approach is to do both option one and option two at the same time, but only after getting the diagnosis confirmed. To get an appointment so you can get on with enjoying life click here