Plantar Fascitis or Heal Pain

Plantar fasciitis means inflammation of the plantar fascia, a strong band of tissue (similar to a ligament) that stretches from the heel to the middle bones of the foot.

Plantar fasciitis is the most common cause of heel pain. Small injuries to the plantar fascia, which supports the arch of the foot, can cause inflammation and pain. The injury is usually near to where the plantar fascia attaches to the heel bone.

Heel Spur
Prolonged inflammation of the plantar fascia can result in the development of a bony growth called a heel spur. In the past it was thought that heel spurs, which were removed surgically, caused heel pain. Doctors have since found that bone spurs are not typically the cause of heel pain and surgery to remove spurs is rare.

CAUSE
Plantar fasciitis is quite common. It mainly affects people over 40 years of age. Other factors that increase the risk of developing Plantar fasciitis include:
• Occupations that require a lot of walking or standing on hard surfaces, including factory work, teaching, retail and hospitality work
• Athletic activity that puts pressure on the heel e.g. running, ballet and aerobics
• Overuse or sudden stretching of the sole e.g. increasing running intensity or distance
• Wearing shoes with poor cushioning
• Being overweight, which can increase the amount of tension in the plantar fascia. Sudden gains in weight or being overweight can also break down the fatty tissue under the heel bone and cause heel pain. This is called 'fat pad syndrome'.
• High arches or flat feet
• Tightness of the Achilles tendon (at the bottom of the calf muscles above the heel).

SIGNS AND SYMPTOMS
Plantar fasciitis usually develops gradually in one foot. Less commonly it can affect both feet and have a sudden and severe onset. Symptoms include:
• Sharp pain anywhere on the underside of the heel
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
• Heel pain after long periods of standing or after getting up from a seated position
• Heel pain after, but not usually during, exercise
• Mild swelling of the heel.

TREATMENT OPTIONS
As with all medical conditions see your Doctor for an accurate diagnosis and treatment. Your Doctor will ask you about your symptoms and look for points of tenderness in your foot. This can help rule out other causes of heel pain, such as tendinitis, arthritis, nerve irritation or a cyst. Your Doctor may also suggest an X-ray or magnetic resonance imaging (MRI) to ensure you do not have a stress fracture. When the cause of your heel pain is identified and managed the pain will usually ease over several months. The following measures may help to speed up the recovery process.
• Rest the foot as much as possible.
• Choose shoes with cushioned heels and a good arch support.
• Use heel pads or custom-fitted arch supports (orthotics) in your shoes to cushion the heel.
• Pain relief such as paracetamol will help to ease the pain. Anti-inflammatory medication such as ibuprofen may be useful. Your doctor may suggest one or two injections of corticosteroid medication into the region of the plantar fascia attachment at the heel for temporary relief.
• Strapping or taping the arch of the foot may be helpful either as a treatment measure or to determine if arch supports or orthotics will be beneficial.
• An ice pack can help to relieve pain by reducing inflammation. It is advisable to apply the ice pack to the heel for 15 to 20 minutes after exercise or daily activities.
• Your Doctor may refer you to a Physiotherapist to instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen foot muscles and muscles in the lower leg which stabilise your ankle and heel.
• Your Doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.
• In a small percentage of people surgery may be required to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

PHARMACIST'S ADVICE
1. Rest your affected foot as much as possible.
2. Ask your Pharmacist to recommend a suitable type of heel pad or heel cup to insert into your shoe.
3. Ask your Pharmacist about some anti-inflammatory and pain relieving medication that may provide some temporary relief from heel pain.
4. Applying an ice pack to the painful area can help to relieve pain by reducing inflammation. A flexible cold pack from your Pharmacy or crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because these can be moulded to the foot, increasing the contact area.
5. Ask your Pharmacist to demonstrate the correct method for strapping or taping the arch of the foot
6. Follow any stretching and strengthening exercises recommended by your Physiotherapist e.g. practise picking up a towel off the ground with your toes.
7. Wear protective shoes when playing sport or when walking. This will support the heel and help to prevent jarring.
8. Being overweight may worsen the severity of Plantar fasciitis. Ask your Pharmacist for advice about how to lose weight.