Plantar Fasciitis: The Real Reason Behind Your Heel Pain

You wake up. You get out of bed. You walk a couple of steps towards the bathroom and there it is. A piercing, stabbing sensation just below the heel.

Some people say that it feels like you are stepping on a nail. Others claim that it is like a tight string underneath the foot. Either way it is not a nice beginning of the day.

What's weird is that the pain may subside after walking around for 10-15 minutes. You wonder, maybe it's nothing. Then, you stand for long periods of time at work, or get up to take a break and get back up, and it's back again.

This is one of the most frequently seen patterns with heel pain, and in most instances, the problem is due to a condition known as Plantar Fasciitis.

What Is Plantar Fasciitis?

There is a thick band of tissue under your foot, from your heel bone to the base of your toes. This band is known as the plantar fascia. It provides support to the foot arch and shock absorption with every step.

This tissue becomes over-stimulated by excessive pressure, activity, or lack of support, and begins to become irritated and inflamed. Small micro-tears can occur at the area where the fascia connects to the bone near the heel. It is the inflammation that will lead to pain.

It's not so strange that it hurts the most in the morning! During sleep, your foot is relaxed and the fascia tightens overnight. At the moment you step onto it with your first foot, the tight tissue is suddenly stretched, which is when you feel it most.

Who Does It Affect?

Plantar fasciitis can cause heel pain in nearly everyone, but it occurs more often in some groups:

• Those individuals who work on their feet for extended periods of time, such as teachers, nurses, or shopkeepers, factory workers.
• Individuals who suddenly increased the amount of walking or running, such as beginning an exercise regimen to improve health and experiencing pain in the heel after 10 days or so.
• Those who wear hard, flat shoes or footwear without an arch every day of the year.
• Patients who are overweight (placement of excess body weight places extra stress on the plantar fascia with each step).
• Those with very tight calf muscles, more prevalent than people think, and tight calf muscles directly impact on how much strain comes on the heel.
• This also depends on age. Most often it happens in the age range of 40 to 60 years, although it may occur in younger individuals, particularly runners and athletes.

Common Complaints We Hear

Typically patients will present with one or more of these complaints:

• Pain in the heel, particularly after getting out of bed in the morning.
• The foot becomes tight or stiff after sitting or lying for a period of time.
• Easily becoming tired while standing for extended periods of time.
• It's more painful on hard floors like tiles or concrete.
• Mild swelling or tenderness when pressing the bottom of the heel.
• Pain that gets worse with movement and better with rest.

Many people ignore these symptoms for months and think that it will go away. It often calms down at times. But in many cases can be more resistant and difficult to control difficult if not treated.

What Are the Causes of Plantar Fasciitis?

There is no single cause. Most of the time, it is a combination of factors.

• Tight calf muscles is one of the most underestimated causes. If your calf is tight, it reduces the range of ankle bending, and increases the stress on the plantar fascia. Minimal stretching can have a big impact.
• Footwear issues occur very frequently. They can be from flat slippers with no cushioning, worn shoes, or shoes not suited to your foot type. Many of the patients are aware that the pain began at the time of new shoes.
• A sudden uptick in activity is another common trigger . It takes time for the body to acclimate. A walking fascial may not be able to handle the five kilometres per day.
• Standing for long periods of time on hard surfaces stresses the heel over and over. Over time, this leads to inflammation.
• Weight adds pressure. A mere loss of weight can help to lighten the load on the foot by a lot.
• Foot structure, people with flat feet or very high arches may be more prone to plantar fasciitis because of how weight is distributed across the foot.

What Is the Treatment for Plantar Fasciitis?

The bright side of plantar fasciitis is that treatment is effective, particularly if the condition is identified early.

• When there is fresh pain and inflammation, ice is usually more beneficial than heat. Use ice for 10-15 minutes after activity or at night when pain is likely to be at its peak.
• Proper recovery takes place during physiotherapy. In physiotherapy, we normally employ a variety of:
• Stretching exercises for plantar fascia and calf muscles. These are easy, can be done at home and are often the one thing a patient can do that makes the most difference.
• Strengthening exercises for foot and ankle muscles that support the arch.
• Ultrasound therapy stimulates blood flow and healing process while reducing inflammation.
• TENS (Transcutaneous Electrical Nerve Stimulation) for pain management
• Soft tissue massage and mobilisation to relieve tightness in the calf & foot.

Footwear correction

In a short period of time, supportive shoes with an adequate heel pad and arch support can make a tremendous difference in footwear correction. Sometimes custom orthotics (insoles fashioned to fit your foot) can be prescribed.

Activity modification

Complete bed rest is rarely required, too much rest can sometimes be harmful. The aim is to remain active, but minimise activities which worsen the heel. During the "painful" stage, refrain from running, jumping and extended barefoot walking.

When to see a doctor

Severe pain, limping, obvious swelling and lack of improvement after 4-6 weeks of home care are signs it's time for a proper evaluation. Sometimes, other treatment options such as injection therapy or further imaging are required.

Can It Be Prevented?

After pain is controlled, the next step is to prevent its recurrence.

• Wear proper footwear: not too thin or flat for everyday wear. Your feet need to be supported properly.
• Stretch your calves and feet daily: before and after exercise, in the morning before arising and every day.
• Increase activity gradually: If you are beginning a new exercise program, slowly increase over weeks and not days.
• Avoid prolonged barefoot walking on hard floors (particularly tile and marble floors) without shoes or socks on.
• Maintain a healthy weight: even a little bit will help lower foot load.
• Replace old shoes regularly: over time worn out shoes lose their cushioning.

Conclusion

Most people affected by heel pain get better. In most cases plantar fasciitis does not need surgery or long-term treatment with medication. With the proper stretches and suitable shoes and a little patience, the improvement will be much more apparent.

The main thing is not to procrastinate. The sooner you begin the quicker and better the recovery.

If you've been suffering from that ache in the heel every morning for a couple of weeks, then now is the time to take notice.

Small steps, taken consistently, make all the difference