Plantar Heel Pain

Plantar heel pain (pain underneath the heel) is a condition affecting 1 in 10 people in their life time. There are a few names floating around relating to plantar heel pain so let's explore them! The most common term that people have heard of is “plantar fasciitis” - this means there is inflammation of the plantar fascia and should only be used if inflammation is present (see below for a description of the plantar fascia). Health professionals will use the term “plantar heel pain” until the structure causing the pain is determined. If the plantar fascia is to blame, “plantar fasciopathy” may be diagnosed. This means that there is a disorder of the fascia.

What is plantar fasciopathy?

The plantar fascia is tough connective tissue that runs underneath the foot from the front of the heel bone (calcaneus) towards the toes and supports the arch of the foot. Plantar fasciopathy is a disorder of this connective tissue that causes pain and structural changes to the tissue. Pain is usually at the insertion point at the calcaneus but this it may also present elsewhere in region.

How is it diagnosed?

Diagnosis of plantar fasciopathy only requires “palpation” (fancy word for poking and prodding) by a physiotherapist or other health professional in conjunction with comprehensive history taking. If in doubt, ultrasound may be used but is rarely required. A physiotherapist will also perform a range of physical tests on the foot and ankle to exclude other conditions.

Who tends to get plantar fasciopathy and what causes it?

Plantar fasciopathy can affect any and all people but there are two main groups that are though to be affected more commonly

1. runners (more running means increased likelihood of developing it)

2. those who are overweight (particularly those who are flat-footed)

How is plantar fasciopathy managed?

Plantar fasciopathy is condition that requires patience and persistence to manage. Management options are sequential and will depend on response to the treatments.

1. Initially, behaviour change is important to ensure the pain does not worsen

- if spending much of the day standing, aim to reduce this

- if running, reduce training volume (may need to replace to with another form of cardio exercise)

- if overweight, weightloss

- pacing, that is monitoring pain levels and resting when pain worsens

2. Then the less invasive physiotherapy/podiatry treatments should be trialled, this may include:

- stretching of the plantar fascia (more effective than calf stretches)

- orthotics (store bought are fine!)

- taping

- strength training

3. After some time, your physiotherapist may feel it helpful to consider other modalities:

- cortisone injections

- shockwave therapy

4. A last resort is surgery but this presents higher risk of adverse events and should only be considered in extreme circumstances.

If plantar heel pain is an issue for you or a loved one, or becomes an issue in the future, our physiotherapists can help you with evidence-based road to recovery.

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