The most common cause of heel pain in both the athletic and non-athletic population, is a condition called plantar fasciitis. The suffix ‘itis’ is used to describe an inflammatory condition – in this case the inflammation is of the plantar fascia, which is dense fibrous tissue that connects the heel to the forefoot. As you can see by this MRI image below, the plantar fascia (long black line identified by white arrows) continues around the heel into the Achilles tendon (blue arrow) and is what connects the calf to the heel.
Even though the Achilles tendon and plantar fascia are named differently, the tissue of the plantar fascia behaves remarkably more like a tendon than a fascial band.
Tendon tissue does not need much blood flow to function normally. One of its major functions is to store energy and recoil when required. This aids in explosive activities such as jumping to provide more force than the muscle contraction alone. It is therefore not a surprising that people with long tendons are better suited to sprinting and jumping sports as more tendon tissue increases their explosiveness. Tendon’s lack of requirement for blood results in the tendon lacking the ability to respond to changes in stress and load to the tissue. This makes both Achilles tendon issues and plantar fasciitis a potential problem when someone:
Starts a new activity
Changes their footwear or increases barefoot activity
Uses shoes that have lost their cushioning
Changes the type of training/exercise they are doing
Increases the time spent on their feet each day
Puts on weight
Injures another part of their body and changes forces through their feet
Gets tight calves or weak calves that puts more load on the plantar fascia
The classic symptom described by sufferers of plantar fasciitis is pain in the heel that is worst with the first few steps in the morning, and when moving after long periods of rest. In the milder stages of this condition, pain will ease with movement
There are often misconceptions that flat feet are a cause of plantar fasciitis, however there is no literature that confirms this is the case. The other factors which can increase load on the plantar fascia, which a skilled physiotherapist will identify. Plantar fasciitis is one condition that seems to get more attention in online postings than other injuries, but be warned; quite a few of the suggested types of treatment may actually be making your problem worse!
To fix plantar fasciitis, you will need a whole lower leg assessment that clearly identifies the contributing factors for your plantar fasciitis and these addressed as required. You will also need to be shown how to reduce load through this inflamed fascia with shoes, tape or other means. Anti-inflammatory medications may be part of the suggested treatment. Once your pain has begun to settle, you will need a very thorough, well structured, progressive build of load in the tendon which will be done based on how your tendon is behaving – we are often guided by the duration of morning pain. This progressive load is an absolute must otherwise it is likely the problem will return.
Plantar fasciitis is one of the specialties of Malvern Physiotherapy Clinic and its physiotherapists are very experienced in fixing this condition.