Not all heel pain is plantar fasciitis

If you have ever suffered with plantar fasciitis you KNOW how painful it can be - It’s worse first thing in the morning right? I remember having to walk sideways down the stairs like a crab to avoid the pressure through my heels. It can also be worse after periods of inactivity, if you have to stand for a long time, also after walks and runs.


Plantar fasciitis is a very common cause of heel/foot pain - You have a thick band of tissue that runs underneath your feet from your heel towards the base of each toe it's called the plantar fascia. This fascia can become inflamed can ultimately cause you ALOT of pain, especially in your heel every time you take a step.

You can usually see the area of inflammation on the inside edge of your heel (see picture below) it can appear red and/or swollen, and it is painful when you touch it. You can have it in both feet at the same time - OUCHHHHHH.......


Plantar Fasciitis can last for months or even years if not treated - so don't ignore it



Main Characteristics of Plantar Fasciitis

  • Pain in the heel

  • Pain worse in the night, first thing in the morning or after periods of inactivity

  • Redness and or swelling on the medial calcaneal attachment of the plantar fascia (see below)

  • Pain aggravated by activity and impact

The plantar fascia should lengthen and recoil to transfer the potential energy from ground reaction forces with every step you take. Where the fascia lacks elasticity or stretch the tissue can start to micro-tear during dynamic movement which is why runners are susceptible to plantar fasciitis, as are dancers, fitness instructors and athletes. Although non-athletes are also prone to plantar fasciitis because we walk on our feet every single day... These micro-tears are associated with the pain and inflammation associated with plantar fasciitis.


Risk factors for plantar fasciitis

  • Limited mobility in the plantar fascia and achilles tendon

  • Excessive impact forces

  • An everted foot type (over-pronators)

  • Walking & running with foot turn out

  • Increased body mass index in the non-athletic

  • Insufficient ankle mobility

  • Footwear that encourages toe extension (trainers with toe spring)

  • Footwear with heel lift that change the mechanics of the foot

  • Footwear with toe spring and heel lift!!!!

  • Cushioned footwear*

  • Supportive footwear that prevent the natural function of the foot

  • Narrow footwear that inhibits the natural function of foot mechanics

*Cushioning in shoes has been associated with an increase in impact forces because we have to strike the ground harder, why? when we block the plantar receptors in the bottom of our feet we skew the perception of how hard we need to strike the ground.


It was thought that increased cushion would help reduce impact related injuries whereas actually it increases impact forces and associated injuries.


REDUCE THE RISK FACTORS

PREVENTION IS BETTER THAN CURE


How do I prevent plantar fasciitis? Reduce the risk factors.

  • Stretch your feet and calves (properly** and regularly)

  • Strengthen your feet to prevent over-pronation when walking and running

  • Mobilise the joints in your feet and toes

  • Make some changes to your footwear (If you are a runner this transition can take a few years or longer for some, so speak to a foot health specialist before starting to transition to avoid injury)

  • Go barefoot as much as possible to naturally regain some normal foot function - this will encourage increased muscle action, which improves circulation and warmth to your feet and in turn also promotes healing.

Picture 1 has the correct back foot positioning to stretch the calf muscles (gastrocnemius)


Incorrect back foot positioning to stretch the calf muscles (gastrocnemius) - rotate your back foot so it points forwards by bringing your heel out and your toes in. This is a very common mistake made when stretching the calf's. (see 2nd pic)


How do I overcome plantar fasciitis?

  • Don't get it in the first place by reducing the risk factors.... Sounds simple because it is... think prehabilitation not rehabilitation

  • Refrain from impact activities

  • Improve the circulation to your feet

  • Roll a ball underneath your feet - avoiding the painful area on the medial calcaneal attachment (see first picture above)

  • Gently stretch your feet - don't over do the stretches - take them slowly

  • Gently stretch your calves

  • Use an anti-inflammatory to help drop the inflammatory process and allow the tissue to move forward in the repair process, either orally or topically

  • Address your foot positioning and function - visit a foot health specialist for advice (book below)

  • You can use overnight sock splints, which holds your foot in a dorsi-flexed position which helps reduce the intense pain in the morning

  • Visit a Foot Heath Specialist for myofascial release of the foot and lower limb Book Here

Your Feet Matter Look After Them


Nikki x

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