Feet Arches

The Arch Enemy – The Complete Guide to Plantar Fasciitis

As they looked up at me, my heart sank. “Is it what I think it is?”, they asked, eyes welled with an emotion I couldn’t quite put my finger on.

“Looks like plantar fasciitis”, I stated cautiously.

“yes! I was right!” they gushed. Never have I seen someone so gleeful about foot pain, as two Google printouts and an assortment of brochures cascaded onto my desk from the catacombs of a handbag that would have done Mary Poppins proud…

I then spent the next five minutes explaining the nature of the condition, how I knew it wasn’t one of the other 46 conditions that make that part of the foot hurt, what we could do, what we could expect and of course, what we couldn’t and then it hit me. They’d found it on the internet. You’re on the internet.  Why not find my thoughts instead and save both of us a whole lot of angst? Besides, I can’t really get grumpy and superior if you’re quoting me back to me, as much as I realise what an essential part of the whole treatment theatrics that is…

What is Plantar Fasciitis?

On the underside of your feet, there is a band of thick connective tissue running between the inner aspect of the heel and the front of your foot. It’s called, funnily enough, the Plantar Fascia, and it plays a pivotal role in keeping all the moving parts down there in position, supporting your arch and help you push off when walking or running by facilitating the natural locking and unlocking mechanisms that allow a bag of individual bones to behave like a solid lever. This tissue doesn’t stretch, so when you put too much tension on it for too long without the chance to recover, your body tries to heal it by starting an inflammatory process. Voila. Plantar Fasciitis.

What Causes Plantar Fasciitis?

Plantar fasciitis is what we loosely term an “overuse injury”. This means that on any given day, using your body, there is an element of wear and tear and a subsequent maintenance cycle that gets you ready to face the new day. When there is too much pressure on the tissue, it can be difficult for your body to complete the catchup before you start placing pressure on it again, effectively starting your day in deficit from the day before. And then one day you wake up and, well, you’ll know it if you feel it. 

A couple of other factors can predispose people to plantar fasciitis though. For instance:

  • Anatomy: If your feet aren’t functioning well anyway, be it variations in arch behaviour, altered pathways of motion to compensate for things that aren’t working well.. for whatever reason (and it’s usually one we can see), there is more loading than we’d like on the origin of your plantar fascia.  This makes it harder for your feet to perform well and they usually let you know how they’re feeling, so you back off and give them time to rest..
  • Activity: Again, if you use it more, you need more recovery time. If you regularly engage in high impact sporting activities such as aerobics, football, cricket (especially fast bowlers), jogging, ballet or anything else that imparts repeated stress on the heel, you need to allow yourself some recovery time accordingly.
  • Health: People with underlying conditions such as diabetes or arthritis are at elevated risk. In both cases, pressures under your foot are increased and the tissue stress has to go somewhere. If you have anything like that, we should really be seeing more of you.
  • Body Weight: Not you of course, but for other people (the author, for instance), being overweight puts additional strain on the connective tissue, which can lead to damage and inflammation to repair it. Similarly, pregnant women may find that the increase in body weight, combined with a shift in the centre of gravity as the baby grows can have a similar effect. Outlying factors, like moving house can also add to the physical stress. Look after yourself.
  • Lifestyle: Individuals whose occupations require them to spend a lot of time on their feet can be predisposed to Plantar Fasciitis. At this point, I can feel your sympathy for parking inspectors just gushing to the surface. It’s almost palpable. By the way, bad or worn out shoes don’t help the cause either.

The insidious thing about Plantar Fasciitis is that it can often strike with little or no warning. In general, it can be triggered in two ways:

  1. Traction – repeated over-extension of the tissue over time, frequently due to poor foot biomechanics, weak arches or repeated stress. Sorry folks. We’re probably talking orthotic treatment at this point, as well as a few adjuncts that we can personalise to your needs.
  2. Compression – trauma caused by extreme impact or stepping on a sharp object causing bruising.

What Are the Symptoms of Plantar Fasciitis?

If you regularly feel like someone is stabbing you in the inside portion of your heel, you may have Plantar Fasciitis. In some cases, it is accompanied by a visible swelling of the heel. This heel pain is usually not constant or consistent, but will typically be felt most acutely at the following times:

  • When taking the first few in the morning after getting out of bed.
  • After an extended period of sitting or standing in one position.
  • After exercise, but usually not during the physical activity itself.
  • When climbing stairs or standing on tiptoes

Remember, there are 47 known things that cause plantar heel pain and they aren’t all managed the same way. Some can be quite minor, but not all of them, so it’s important we establish what your particular diagnosis is before treating anything.

How Can Plantar Fasciitis be Prevented?

Although Plantar Fasciitis can’t be completely prevented (in truth, we can try all sorts of measures, but we have no way of knowing that the reason you don’t have it is because of them, rather than just that you didn’t contract it), there are ways we can reduce the likelihood of you needing your Google printouts.

  • Maintain a healthy weight to avoid unnecessary burden on the connective tissue
  • Ensure you choose good quality, comfortable shoes with plenty of support, especially if your day involves a lot of standing or walking around on hard surfaces.
  • Avoid stilettos, excessively low heels, worn-out runners, any form of open-backed shoes (sandals, thongs, slippers) or going barefoot
  • Warm up well and gradually increasing the intensity of physical activity
  • Ensuring adequate recovery time between exercise or sports sessions.
  • Be conscious of colder weather, as your muscles are tighter and will tend to stress corresponding tissues as a result.
  • Take care of foot problems. If the mechanics of your feet are performing badly, get them seen to. Think about it.. you’d wheel balance your car. Why not your body? Besides, it’s harder to replace.

How is Plantar Fasciitis Treated?

Once we know that’s what the diagnosis is, there is good news. Although it can take some time and a little effort on yoru part, we can usually treat it quite successfully. Sufferers will see marked results within 2 months with proper care. Treatment options include:

  • Early icing to reduce swelling
  • Rest and reduced activity, particularly those that may exacerbate the injury
  • Orthotics to redistribute pressure away from the affected area, reduce stress on the tissues and facilitate proper foot mechanics so that the condition has a reason to get better after all
  • Therapeutic exercises to gently build strength in the affected tissue
  • Non-steroidal Anti-Inflammatory medications in severe or persistent cases.
  • Dry needling

There you have it; everything you never even knew you wanted to know about Plantar Fasciitis. If you’re feeling that telltale stabbing pain in your heel and you’re past that stage where you think it will simply go away quickly by itself, contact the Lower Limb Clinic today or make an appointment and we’ll be happy to get you back on your feet as soon as possible. 

It’s what we do.