Plantar Fascia/Heel Pain
This is by far the most common condition affecting the foot; one in ten people develop it at some time in their life. It is most common in people between the ages of 40 and 60 years; however, it can occur at any age. Women are twice more likely to develop this condition than men. It is also common in athletes. The good news is that with appropriate advice and treatment this will resolve for the vast majority of people.
Treatment protocols for heel pain almost always start with basic principles and we would encourage you to consider trying some self-help treatment before making a referral to your local Podiatry department.
What is the plantar fascia?
The plantar fascia is a strong fibrous band that stretches from the heel to your toes. It is made up of three bands that run along the inside, middle and outside of the bottom of your foot. The inside and outside bands support the arch and act as shock-absorbers. Shock absorption is important as it reduces the impact your body weight has on the foot when walking, running and carrying out any weight-bearing exercises. Not only does the plantar fascia support the arch, but it also stabilizes the foot to allow you to push off through your toes.
When pain develops in the plantar fascia, it can be very disabling. Every step can become more painful and cause you to change the way that you walk. When this happens it can lead to strains to other parts of your body.
Plantar fascia pain or Plantar Fasciopathy is the most common condition affecting the foot. The condition is usually diagnosed by clinical findings alone.
Classic signs and symptoms:
- A gradual onset of pain affecting the base of the heel
- Pain in the heel during the first steps when you get out of bed in the morning
- Pain in the heel when weight bearing after a period of inactivity or rest
- Pain that eases or lessens with moderate activity
- Worsening pain later on during the day or after long periods of standing or walking
What causes the problem?
In most cases Plantar fascia pain or plantar fasciopathy develops as a result of changes to the way our foot functions with small tears occurring within the plantar fascia. These injuries happen at a rate faster than the body can heal them and as a result the plantar fascia starts to become thickened and painful. The pain is most commonly felt under the inside of the heel but can be anywhere along the bands of the plantar fascia.
Other contributing of factors
- Being overweight
- Weakness in the muscles within your feet or leg
- Tightness in the muscles up the backs of your legs
- Wearing unsupportive footwear such as shoes or sandals which have a low heel and don’t support the feet
- Spending long periods standing or walking, especially with a sudden increase in these activities
- Jobs that involve standing or walking on hard surfaces for long periods of time
- Sudden increase in physical activity levels - for example, recently started running
Things to consider
Heel pain is not only limited to just plantar fasciopathy. There are a number of other conditions that cause heel pain.Other factors such as Tarsal tunnel and Baxters nerve entrapment, Bursitis, Infection, Enthesitis (site where the tendon attaches to the bone), Stress fracture and Tumour can also present as heel pain.
What can I do to help?
Unfortunately there is no quick or easy fix and your symptoms won’t improve overnight. Plantar fascia pain is self-limiting and in many cases will improve without any treatment. It is important though that if you have any of the contributing factors you make the necessary changes to help your recovery. The one person who can help you manage your symptoms is you!
Weight management
Increased weight will place extra stress on the joints and soft tissues in your feet. Losing even a small amount of weight will make a big difference to this especially when walking, running, or going up and downstairs.
If you need help with weight-control, you can find information, advice and groups you can join to help you manage your weight better. Follow this link to an NHS BMI Calculator (https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/) to guide you on whether you should consider weight management.
Footwear
Shoes that have flexible soles generally offer the foot less support and can increase the stress in soft tissues such as your plantar fascia. If you have shoelaces make sure they are tied appropriately. Avoid wearing hard, flat or unsupportive shoes.
Pain Management
Pain medication can help reduce your symptoms, allow you to move more comfortably which will aid your recovery. Your community Pharmacist can provide guidance on specific medication or other methods of pain relief (always read the label and manufacturer’s guidelines).
Injury Management
The P.O.L.I.C.E guidelines describe what you should do for the first 24 to 48 hours after suffering a mild sprain, strain or sports injury.
Protection- Protect or support your injured body part for the first 24 to 48 hours after injury. Use a light bandage to support the injury.
Optimal Loading- Early activity encourages early recovery. The key of optimal loading is movement of the injured area within a pain-free range to help promote optimal healing.
Prolonged rest could lengthen your recovery period and it may impact on your health and wellbeing.
Ice- If you've had an injury or flare-up in the last two days:
• wrap crushed ice in a damp towel
• hold it for 20 minutes against the part of your body that hurts. Make sure you use a damp towel between the ice and the skin to avoid ice burn
Alternatively, you could try sports sprays and gel/cool packs, which do a similar job. You can do this every two to three hours.
Should I use a heat pad?
After two days, you may find that heat is more relaxing. You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and is not directly touching your skin. You should do this three to four times a day for 10 to 15 minutes.
Compression- Apply compression with a bandage or tubi-grip type of support until the swelling goes down. Wrap the bandage starting from the end furthest from your heart. Loosen the bandage if the pain increases or the area becomes numb.
Don't make the bandage too tight and do not wear tubi-grip or any compression bandage in bed at night.
Elevation- Elevate your foot / ankle above the level of your heart as much as possible during the first 24 to 48 hours, especially when sitting or lying down. Make sure you use pillows underneath your foot for support.
After 48 hours:
-Try to weight-bear more, loading with a limp is generally normal in this phase, exercise can help relieve pain
-Do whatever you normally would and remain at work, or return to work
-Avoid sports or heavy lifting until you have less discomfort and improved movement
If you are in pain do not try and do all your normal daily activities such as housework, at once. Break the harder jobs down into smaller time frames and do something gentler in between. Extensive walking or standing should be avoided if it aggravates your pain. It is recommended to modify activities rather than to fully stop all forms of movement or exercise, so try swimming or cycling instead of walking or running.
Strengthening and Stretching Exercises
Current evidence based strengthening and stretching exercises for the muscles in and around your foot and ankle can help to improve your heel pain. Your podiatrist will advise you which exercises are suitable for you.
Strapping
Strapping/Taping can be used to help support the arch of your foot and reduce some of the load on the plantar fascia. This can be a useful short term treatment that can help reduce your symptoms. Your podiatrist will advise you on this.
Patience
Have patience, most people’s symptoms should start to improve within three months of following this advice.
Frequently asked Questions
The following information aims to ensure a person-centred approach in the first stages of managing your problem. For this to be achieved, practitioners aim to meet your expectations and needs of your presentation and address any concerns you may have and enable shared decision-making process.
We hope the following questions that have been developed on the back of MSK focus groups, will provide you with some answers with provide you with key information around your condition.
• What is wrong? Why? What is the cause? Plantar fascia pain or plantar fasciopathy develops as a result of changes to the way our foot functions. As a result small injuries start occurring within the plantar fascia. These injuries happen at a rate faster than the body can heal them and as a result the plantar fascia starts to become thickened and painful. The pain is most commonly felt under the inside of the heel but can be anywhere along the bands of the plantar fascia.
Other contributing factors:
- Being overweight
- Weakness in the muscles within your feet or leg
- Tightness in the muscles up the backs of your legs
- Wearing unsupportive footwear such as shoes or sandals which have a low heel and don’t support the feet
- Spending long periods standing or walking, especially with a sudden increase in these activities
- Jobs that involve standing or walking on hard surfaces for long periods of time
- Sudden increase in physical activity levels - for example, recently started running.
• What is the possible impact on my health and function? It can be very disabling, each step can become painful, which in turn can lead to strains elsewhere in the body.
• Will I get better or worse? The good news is that with appropriate advice and treatment this will resolve in the vast majority of cases.
• Is it curable? Unfortunately there is no quick or easy fix and your symptoms will not improve overnight. Plantar fasciopathy is a self-limiting condition that requires possible consideration of a change in lifestyle and by modifying the known causes as previously mentioned can reduce your symptoms from getting worse. The one professional who can help you manage your symptoms is you!
• How long will it take to get better? Most people’s symptoms should start to improve within 3 months of following the self-help advice, but can take several months to achieve a significant improvement.
• What are you (the health professional) able to do about my problem? By using our self-help tool, we would like to help you to better understand your condition and provide you with the tools which should help support your recovery.
• What is the treatment that is most appropriate for me? Treatment protocols for heel pain almost always start with basic principles and we would encourage you to consider trying some self-help treatment in the first instance before making a referral to your local Podiatry department.
• What can I do to help myself to alleviate it? We would encourage you to consider trying some self-help treatment in the first instance before making a referral to your local Podiatry department. Pain medication can help to reduce your pain and help you move more comfortably and help aid your recovery. Speaking to your community Pharmacist can provide guidance on specific medication or other methods of pain relief.
• How can I reduce or control my pain? Pain medication can help to reduce your pain and help you move more comfortably to help aid your recovery. Speaking to your community Pharmacist can provide guidance on specific medication or other methods of pain relief.
• How can I maintain my function and do the things I want to and need to do? Optimal Loading- Early activity encourages early recovery. The key of optimal loading is movement of the injured area within a pain-free range to help promote optimal healing. Prolonged rest could lengthen your recovery period and it may impact on your health and wellbeing.
• What activities can I do and how should I adapt them (e.g. sports, work)? Avoid high impact activities like running or activities which involve long periods of standing which will significantly increase load through the plantar fascia, we would encourage you to participate in low impact activities like walking, swimming, cycling etc.
• Have I made an improvement? Most people’s symptoms should start to improve within three months of following the self-help advice, you should notice that although you may still have episodes of pain they will becoming less frequent and severe.
Why am I not improving? Where have I gone wrong? Am I doing the right things? There are a number of reasons why your symptoms may not be improving within three months of following the self-help advice. In this case we would advise you to make contact with one of our MSK Podiatry clinics for further advice/assessment.