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Plantar heel pain is also commonly known as Plantar Fasciitis. The term ‘fasciitis’ is used much less nowadays as it suggests inflammation is the primary cause of pain which we now think is unlikely. The plantar fascia is a band of tissue that runs from the heel to the front of the foot supporting the arch of the foot. When this becomes irritated or injured pain is felt in the heel and sometimes spreads to the arch of the foot. Pain is often worse when standing or walking too long and after rest, for example, when taking the first few steps after getting out of bed or after sitting for a while.
People develop plantar heel pain for a number of reasons and there is still a lot to learn about what is actually going on in the plantar fascia. It is generally considered to be a condition that is caused by irritation of the fascia when it is overloaded and struggles to cope with the demands put through it. For example, this could be due to changes in exercise habits, weight or shoes which alter the load on the plantar fascia. It can also be due to poor biomechanics of the foot such as reduced ankle or big toe movement.
Plantar heel pain affects up to 10% of adults and is especially common in men and women over the age of 40. It is very common in people who stand, walk or jog for prolonged periods of time.
Research has found that your general health and lifestyle can have an effect on how healthy the tissue is. For example having a high BMI and being diabetic, especially type 2, increased the likelihood of having plantar heel pain.
It is known that in the general population 1 in 10 people have heel spurs, however only a small number of these people (5%) of these have plantar heel pain. Therefore we cannot say there is a direct link between plantar heel pain and heel spurs. In fact, orthopaedic surgeons will not remove heel spurs anymore as it was found not to help with patients’ pain.
A thorough examination from your GP or physiotherapist will usually be sufficient to diagnose plantar heel pain.
The initial focus of your rehabilitation is to reduce the pain through what activity you do and how much load goes through the foot. Temporarily you may need to reduce the amount of standing, walking, or running you do but it is important you do not stop activity completely. You may find that a change in footwear such as wearing supportive, well cushioned trainers or using gel heel insoles may help make it more comfortable when you are on your feet.
Research has shown that strengthening and stretching exercises for the plantar fascia increases its ability to take load and should be started as soon as possible. Your physiotherapist can advise you on exercises to gradually increase the load put through the tissue. The rehabilitation process takes hard work, patience and commitment and it may take some months to become pain free.
While doing your rehabilitation exercises it is common to experience some pain. This pain can persist for a short time after finishing the exercises and this is generally nothing to be concerned about. Your physiotherapist can discuss how long and how severe the pain is, but usually if the pain is acceptable to you then it is fine to continue with the exercises. Pain does not mean you are causing damage to anything.