Want to stop reading and start living? Call your closest clinic today and make an appointment. Otherwise, the answers the the 9 most asked questions about heel pain and plantar fasciitis are revealed below.
For more information about Plantar Fasciitis, heel pain and treatments please read below. We will discuss:
- What is Plantar Fasciitis?
- Why do you get Plantar Fasciitis ?
- Is Plantar Fasciitis the same as a Heel Spur ?
- Treatment options for Plantar Fasciitis
- Why does Plantar Fasciitis last so long ?
- How long does it take to recover from Plantar Fasciitis ?
- What are the best shoes for Plantar Fasciitis ?
- What else might cause heel pain that isn’t Plantar Fasciitis?
- Do you need to have an X Ray to diagnose Heel Spurs?
Heel pain can be a terribly debilitating condition that can last for years if untreated. Every day we see people who have been told by their family doctors that there is no treatment available and it will go away eventually. This can be true. In a fair number of cases, plantar fasciitis will go away eventually without treatment. ‘Eventually’ though, could mean literally years and years of pain and disability. Even then, it is very likely to recur after a time.
It is simply not true that you have to suffer this condition with no relief.
Heel Pain in a Child
This condition is one that predominately affects adults. If the pain that you are researching is Heel Pain occurring in a Child, please see our section on Sever’s Disease.
What is plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain on the bottom surface of your foot. The plantar fascia is a thick band of gristle that runs from the heel to the ball of the foot. It covers a large area of the sole of the foot. Unlike a tendon or a muscle, the fibres that make up a fascia are very rigid. It has a medial band which is on the inside / big toe side of the foot. There is also a lateral band that runs up to behind the small toes. It is almost always the inner medial band that becomes painful. The pain is usually bad for the first couple of minutes of standing after rest or sleep. It will then often improve before worsening again with ongoing use. Standing still may be as bad as, or worse, for pain than walking.
Why do you get Plantar Fasciitis?
When your foot is sitting properly, the band stretches across the arch, travelling a particular distance. The higher the arch of the foot, the shorter the distance from the heel to the toes. In a foot that rolls in (flatfoot, pronation, fallen arches) the distance that the plantar fascia has to cross increases. As the band is not a stretchy structure, this elongation will cause the plantar fascia to pull on its weakest attachment. For most people, this is at a point called the Medial Tubercle of the Calcaneus. This is directly under the heel, shown in the image shaded red.
Other common places for plantar fascia related pain include around the rim of the heel and through the arch. If the tissue is under stress for a long period, the body may lay down extra bone at the Medial Tubercle. This is called a heel spur.
For more information on What causes Plantar Fasciitis, read this in depth discussion on a separate page.
Is Plantar Fasciitis the same as a Heel Spur ?
As far as a diagnosis of your pain goes, the answer is usually yes. The two terms are used interchangeably. However, just because you have heel pain, it does not mean that you definitely have a spur. Likewise, many people have spurs but no pain. It is important to know that spurs don’t cause the pain. It is the pulling that causes the spur to grow and the pulling that causes the pain but the spur does not itself cause pain.
Plantar fasciitis requires professional care to determine the cause of the tissue strain. A podiatrist will be able to treat the plantar fasciitis quickly with high chances of success with a variety of treatment options. By recognising plantar fasciitis early on, the podiatrist will be able to implement a more effective management plan.
Very often we will finish our assessment of your foot condition with an offer to ‘strap you up’. For most people, this is a little taste of magic, often reducing the pain by 50% within minutes.
Orthotics are an important part of the treatment to resolve the condition for most people. This is because the underlying cause of fasciitis is almost always poor foot position creating too much tissue on the tissue. Orthotics have come a long way in recent years and are more comfortable and slim line than ever. See our page on orthotic types for more information.
Extra-corporeal shockwave therapy is a treatment that is designed to alert your body to the lingering injury of fasciitis and bring on repair mode. Blood flow is increased in order to stimulate neovascularisation of the damaged plantar fascia. The shockwave treatment is repeated, often three or four times over a number of weeks. Use of shock wave in plantar fasciitis
The podiatrist can administer an injection around the plantar fascia. This aims to bring about a reduction in the pain as well as to incite tissue repair over a number of weeks. This is particularly useful for a complication of fasciitis called Baxter’s nerve entrapment. You can find information related to prolotherapy and Neural Prolotherapy for ligaments, tendons and joints here. On some occasions, we may use a corticosteroid injection around the point of pain to settle the condition rapidly.
Spurs almost never need to be cut out and surgery is very rare these days.
Why does Plantar Fasciitis last so long ?
Earlier, we discussed that the plantar fascia is a thick band of gristle. At the point of attachment of the fascia into the heel bone, the tissue splits up into thousands of fibres. Each of which punctures the bone to hang on. This anchor point is called an aponeurosis or enthesis. This zone has very poor blood flow. If you were to cut the area surgically, you would squeeze out a few of drops of blood, but nothing like what would flow by cutting skin, bone or muscle. Plantar fasciitis is an episodal condition. This means that, if you are prone to it, you are likely to suffer episodes or ‘attacks’ on and off through your life. An episode might last a month or it could much, much longer. Without treatment, the condition can go on for years.
Due to the fact that fasciitis will come and go, doctors will often say “Don’t worry, it will go away by itself”. This is probably true, but five years is a long time to put your life on hold waiting for it to clear up naturally.
Added to this, the older you become, the less ‘bouncy’ the collagen in your connective tissues becomes. This is the reason you get wrinkles in your skin as you age. It is also the reason why attacks of plantar fasciitis get more severe and more frequent as you age. Furthermore, increases in weight often accompany heel pain, as exercise is difficult. Weight gain can exacerbate the problem and make it harder to treat. For these reasons, plantar fasciitis is best treated early and effectively.
How long will it take to recover from plantar fasciitis ?
This is a multi-part question, with a multi part answer. At the first appointment with our podiatrist, several things usually are achieved. Firstly, a diagnosis will most likely be reached, unless there are complex issues involved. Secondly, treatment options will be discussed. Thirdly treatment will be commenced if you elect to do so. Treatment at this stage may involve Shock Wave Therapy , planning for orthotic supports, shoe advice, stretches (perhaps) and almost certainly taping.
The taping that we would employ binds the two ends of the arch together into a shortened position. This will take the tension off the fascial band immediately. People do vary in their response to treatment but it is not uncommon that it will reduce the pain by 50% within half an hour. So, it is possible to feel better with plantar fasciitis much quicker than it is to actually achieve recovery. Unfortunately, the benefits cease when the tape is removed in the early stages of recovery.
If it is decided to go down the path of making orthotics, they take around a week to make. From here, it will often take 10 days before your orthotics work to peak efficiency. This delay occurs because the foot will start out wanting to continue to work in the same pattern it always has done. You might elect to continue with the taping to reduce pain and keep the momentum of healing going during this phase.
From here, we ask that you return three weeks after the orthotics are dispensed for an assessment. This time frame is no accident ! Usually, at the three week mark, you will have had a good improvement and have happy news to report. We would generally expect you to have reduced your pain by 50% or better within this time frame. However, the damaged tissue of the fascia has very poor blood flow and is slow to repair. You should assume that it will take about three months of walking around with little or no pain before the damage to the fascial tissue is healed. This means that, while your orthotics are off and your arch is unsupported, you will still have some pain. This is particularly so of first-step pain in the mornings. You should aim to be in your supports as often as possible for two reasons. Firstly, pain hurts! Secondly, pain means damage is occurring. Too much pain is telling you that the area is being re-injured and this will slow down your healing unnecessarily.
- Read more about the best shoes for plantar fasciitis here.
- Other conditions that look like Plantar Fasciitis. Coming soon
- Do I need to X Ray Heel Spurs to confirm Plantar Fasciitis ?
Wouldn’t it be nice to Walk Without Pain?