Plantar fasciitis, often referred to as ‘Policeman’s Heel’, is one of the most well-known causes of heel pain. Plantar fasciitis is a disorder of the connective tissue which supports the arch of the foot.
It results in pain in the heel and the bottom of the foot, and is usually most severe with the first steps of the day or following a period of rest – it can feel as if you’ve walked barefoot across a rocky beach.
The pain is further aggravated or can be brought on by bending the foot and toes up towards the shin. The initial experience of pain typically comes on gradually, although I’ve seen cases where the pain has come on quite suddenly whilst out for a walk or run. In about one third of cases, it affects both feet.
Whilst it is not always entirely clear what triggers plantar fasciitis, there are a number of risk factors to consider.
Common Risk Factors
• Wearing shoes that give poor support to the instep or arch of the foot. So typically, in the summer, when we wear sandals or flip flops, the sudden lack of support to the arch of the foot creates tension on the connective tissue, which inserts into the heel bone.
• Similarly, walking you dog or going out in the snow in cheap wellies with no arch support can also be a trigger.
• A sudden increase in the amount of standing or exercise, for example, taking on a new job that involves a lot of standing or increasing the amount of running or walking, particularly on hard ground.
Other risk factors
• A tight Achilles tendon
• A tendency for the heel bone (calcaneus) to inwardly rotate
• The collapse of the instep often referred to as overpronation of the foot
The diagnosis of plantar fasciitis is typically based on signs and symptoms; ultrasound is sometimes useful and an X-ray may be helpful in ruling out a stress fracture of the metatarsal bones.
Medical Treatment Options
• Non-steroidal anti-inflammatories such as Naproxen or Ibuprofen, and painkillers.
• Advice from a podiatrist and prescription orthotics.
• Guided steroid injections.
• Shock wave treatment – pressurised air or electromagnetic pulses to deliver shock waves to the body that initiate an inflammation-like response in the injured tissue, accelerate the healing process and relieve the symptoms of pain.
In my own practice, I’ve found that it’s important to thoroughly assess the mobility of the whole foot and ankle. The Achilles tendon is by no means always to blame. Often, I find the mid foot and big toe are not free to move and mobilising this area can be very beneficial. Acupuncture can be useful to treat the local symptoms in some circumstances.
Looking further afield, the hip stabilisers are also ‘friends’ of the feet. When the heel strikes the ground, the hip stabilisers should be ‘switched on’ to help dissipate the shock and propel you forward in a smooth motion. If the gluts and hip stabilisers don’t get that message and don’t come to the aid of the foot and ankle, then is it any wonder if the poor plantar fascia starts to protest?
If symptoms have come on suddenly after an unusual bout of exercise, kinesiotherapy taping can be helpful. There are plenty of YouTube clips on how to tape the sole of the foot for plantar fasciitis but, having suffered with the condition myself, I cannot say that I agree with any of the methods described.
Perhaps the most important tip is to find comfortable footwear and certainly avoid flat ballet-type shoes or cheaper boat-type shoes. Look for something with a gently molded insole and make sure you try them on for comfort.
For more information on plantar fasciitis or to book an appointment in Bridgnorth or Shrewsbury, please call 01746 761050.