What is that damn pain under my heel!
Plantar fascitis, plantar fasciosis, plantar fasciopathy or plantar heel pain? Call it what you want but it all means the same thing to the sufferer with that annoying at times significant pain under the heel. The plantar fascia is a thick band of fibrous tissue that runs from the heel bone to the bones in the forefoot. To keep things very simple the plantar fascia becomes sensitive to pressure and load (the underlying mechanism are still not completely understood).
Often felt first thing in the morning or with walking and increased time on the feet plantar heel pain affects around 7% of the population with prevalence higher in runners. Symptoms can last from a few weeks to a few years in certain cases.
Increased body weight and decreased ankle mobility have been proven to be the most significant factors in developing plantar heel pain and interestingly foot mechanics and shape has not been found to be a significant factor with inconclusive evidence for abnormal foot posture and abnormal foot motion being causative factors.
Treatment varies between practitioners but can consist of load modification, stretching, orthotics, taping, manual therapy and self-massage and more recently strengthening exercises. Despite differing treatment techniques many cases still fail to respond and there is still no direct consensus on the best management.
More recently Rathleff et al 2014 found high load strength training- (Basically calf raises with the toes flexed up on a towel to load up the plantar fascia- see pic) to have a better outcome in the foot function index which includes pain at 3 months compared with just stretching. Also important to note however that at 6 and 12 months there was no difference. So basically a quicker reduction in pain was found but similar long term effects. And if you ask anyone with the condition they would welcome a quicker reduction in pain levels!
The study protocol exercises should be performed slowly on one foot as seen in the below picture with 3 seconds up, 2 seconds pause at top and 3 second down. Start with 3 sets of 12 every 2nd day and gradually progressing to 5 sets of 8 heavier raises through using additional weight over a 12 week period. (see below pic) and some guidelines for management.
This strength training protocol combined with load management and education is definitely not a miracle cure but is a step forward in finding evidence based treatments for this at times debilitating condition. I think we will see more research on this type of treatment based on this study.
Below is a nice management infographic for plantar fasciopathy from Tom Goom and the clinical edge team.
If you have heel pain be sure to have it properly assessed by your chosen health professional to get a rehabilitation program specific to your individual needs.
Hamish The Physio
