Plantar Fasciitis

Plantar Fasciitis and other causes of Heel Pain

The foot is an amazing and versatile structure that takes all the weight of our body.  It can be rigid to keep us stable when standing but also flexible for walking on uneven surfaces, playing sports or dancing.  The foot consists of 33 joints, 19 muscles,107 ligaments and 26 bones which is a quarter of the number of bones of the whole body!  There are four layers of muscles in the bottom of our feet alone and the skin that covers the bottom of the foot is the thickest layer of skin of all the body.  All these complex structures work together expertly to help us stand, walk, run and dance and to generally keep us mobile.  As you can imagine, there are lots of things that could go wrong in the foot and one of the most debilitating pains that we can experience in our life is heel pain.  It prevents us from taking part in activities that we love and which keep us healthy and can make us down right miserable! Heel pain is a very common condition which can affect people of any age and can be caused by many conditions.  The most common cause of heel pain is Plantar Fasciitis which around 1 in 10 people will experience at some point in their life.  Typical symptoms of the condition are pain in the area of the heel pad when getting out of bed first thing in the morning, when standing for an extended amount of time or after walking for a long period of time and heel pain when getting up after having been sitting down for a long time.  The Plantar Fascia is a band of strong tissue inside the bottom of the foot which stretches from the heel to the bones of the forefoot and acts as a shock absorber and arch support.  The pain that you feel is caused by repeated small injuries to the Plantar Fascia which can be caused by standing for long periods, exercising, or running on different surfaces, wearing shoes with poor cushioning or support, being overweight and overuse or over stretching of the foot. However, there are sometimes no obvious cause of the condition, especially when it occurs in older people which can make it difficult to diagnose.  Some simple treatments that you could try for yourself if you think that your heel pain is caused by Plantar Fasciitis include resting the foot as much as possible, trying to reduce your BMI, not walking around without shoes on over hard surfaces and placing an ice-pack wrapped in a tea-towel against the area of pain for 15-20 minutes at a time.  Make sure that your shoes are in good condition with good cushioning inside (not memory foam type cushioning) and do not put your shoes on or take them off without untying the laces or other fastenings first.

However, although Plantar Fasciitis is the most common cause of heel pain, there are over 50 other conditions that exhibit similar symptoms which, if treated as though they are Plantar Fasciitis, could make the problem worse. Other conditions that produce similar symptoms could be something as simple as a corn or very dry or cracked skin or it could be an arthritic related condition such as Gout, Osteo Arthritis or Rheumatoid Arthritis.  It could be a dermatological condition, a verruca or an ulcer or there could be a neuropathic or mechanical problem such as a fracture, nerve entrapment or Tarsal Tunnel Syndrome or the pain could be caused by heel pad atrophy which is a common occurrence as we age.  In the case of children aged between 10-15, heel pain could be caused by a condition called Sever’s Disease (which is not actually a disease at all but a problem in the young foot which is still growing and developing).  What is important though is that you seek a full assessment and diagnosis by an HCPC registered Podiatrist as soon as you begin to experience heel pain.  The quicker you are able to get a diagnosis, the sooner you will be able to receive some relief, the longer you wait with Plantar Fasciitis, the harder it is to resolve.  Podiatrists specialise in conditions of the lower leg and foot and who have studied the anatomy, physiology and conditions of the foot for at least 3 years at university and are experienced in the assessment, diagnosis and treatment of the various causes of heel pain. 

Carolyn Heller BSc(hons) Podiatry

MInstChP, MRCPod

Heller Podiatry