Plantar fascia pain is the most common cause of chronic heel pain and is a very prevalent condition seen by physiotherapists. It mostly affects people between the ages of 40-60 and there are a number of risk factors that can predispose one to developing plantar fascia pain. This condition is commonly referred to as plantar fasciitis – but what exactly is it?
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What is the Plantar fascia?
The plantar fascia is a taught band of connective tissue that attaches to the bottom of the heel and spans the length of the foot to attach to the balls of the foot. It is made up of highly organised collagen fibres, and is crucial for a normal gait pattern and higher level tasks such as jumping, hopping, running and team sports.
How does plantar fascia pain develop?
There are many risk factors for developing plantar fascia pain. These include age, obesity, high impact activities, certain biomechanical traits or deficiencies, or jobs that keep you on your feet. The causes of plantar fascia pain can be varied, but most commonly involve an overload. This is usually in the form of an increase in physical or daily activity, or a period of activity followed by prolonged rest.
The plantar Fascia, just like any structure in the body, can only withstand a certain amount of loading. When this level is exceeded, the plantar fascia responds by starting to disorganise itself, and the structure becomes weaker. As a result, it can no longer handle the loads it once could, and it starts to become painful as you go about your day.
Plantar fasciitis or Plantar Fasciosis?
The term plantar fasciitis refers to inflammation (-itis) of the plantar fascia. This is the term most commonly used on the internet, in some literature and unfortunately by some health professionals still. In actual fact, most people with plantar fascia pain are suffering from plantar fasciosis – a degenerative condition of the plantar fascia. Fasciitis likely occurs in the first 2-5 days of the condition, but then slowly subsides. What people are left with after several weeks or months of pain is a condition where their plantar fascia has slowly disorganised and degenerated as a result of the overloading (and subsequent unloading as you stop your normal activities due to pain). The condition is degenerative, and therefore will not often be fixed (although can sometimes temporarily improve) by taking anti-inflammatories, using cold packs, or taking a period of complete rest.
How do I know if I have plantar fasciosis?
Plantar fascia pain is most commonly characterised by the following symptoms;
• Very painful on your first steps in the morning
• Painful when walking after an extended period of non weight bearing
• Painful when you start exercise, and slowly warms up
• In more advanced stages it can be sore throughout exercise
• Very tender on the bottom of your heel and the inside edge of your heel
• More painful in unsupportive shoes
• Weakness or inability to raise up onto your toes without pain
What can I do about it?
Whilst plantar fasciosis is the most common source of heel pain, there are also a number of other conditions that can cause your symptoms. The best thing to do is have the condition properly assessed to receive an accurate diagnosis. Most people with plantar fasciosis will require an individually tailored strength program to meet their specific strength needs and goals. There are many other things your physiotherapist can do to assist with symptom management and getting you on the road to recovery.
