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Plantar Fasciitis Brisbane Solutions for Spurs, Heel & Arch Pain

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For more information about Plantar Fasciitis, heel pain and treatments please read below

Frequently asked questions and queries:

  • Why do you get plantar fasciitis? What makes Plantar Fasciitis worse?
  • Achilles Tendon and Calf Pain
  • What are heel spurs? Why did I get a heel spur?
  • What should I do when the heel pain goes?
  • Pregnancy and Feet
  • Should I wear a plantar fascia night splint?
  • Heel Spur, arch pain & plantar fasciitis
  • What is causing my heel pain? What is plantar fasciitis?
  • Is my plantar fasciitis spreading up my leg ?
  • Why does plantar fasciitis last so long? How long does plantar fasciitis last? Why won’t my plantar fasciitis go away? Why won’t my heel pain go away?
  • Shoes / footwear and heel spurs / heel pain / plantar fasciitis
  • Orthotics and Plantar Fasciitis / heel pain / heel spurs
  • How long will I take to get better / recover from plantar fasciitis?
  • Plantar fascia stretches ? Stretches for plantar fasciitis ?
  • Should I get an X Ray of my foot if I have plantar fasciitis / heel spurs?
  • Shoes for plantar fasciitis
  • Treatment options

This condition is one that predominately affects adults. If the pain that you are researching is occurring in a child, please see our section on Sever’s Disease.

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.

Why do you get plantar fasciitis? What makes Plantar Fasciitis worse ?

Plantar Fasciitis

Plantar Fasciitis is an inflammation of a thing called the plantar fascia in the heel and arch of the feet. There are several risk factors that can play in together to cause damage to the tissue and pain to come on. When some or all of these risk factors come together, you can find you get heel pain. Sometimes you can identify the event, like a very long walk or a bad pair of shoes. Sometimes though, it is nothing particular.

The contribution that each of the various risk factors contributes towards causing plantar fasciitis is different for each person. Common risk factors include:

  • Age
  • Weight
  • Foot structure
  • Occupation
  • Surfaces we stand on
  • Shoes
  • Activity level

Age

As you get older, plantar fasciitis is much more common. The graph below shows roughly how common it is with increasing age. Plantar fasciitis is also a condition that occurs in episodes. As you get older, these episodes of plantar fasciitis become more frequent and increase in severity. This is due to changes in the collagen in your body. Collagen is the substance that gives connective tissue structures like the plantar fascia its strength, some of its stretch and its ability to bounce back. As you get older the collagen significantly changes, it becomes weaker, less stretchy and less bouncy. This change occurs in your mid-thirties and is the same reason why we develop wrinkles as we age.

You may have also noticed that as you have gotten older the arches in your feet have lowered. This occurs due to a combination of the change in collagen described that binds all the bones together less firmly, allowing them to ‘spread out’ a bit. As the arches lower, they also lengthen which causes the plantar fascia to be stretched over a longer distance, causing strain.

 

Weight

Our feet are designed to carry the weight of our body. Excess body weight puts extra stress through the bones, muscles and ligaments and creates more pressure that will push the arch down into a flattened position. The plantar fascia is the structure that has most of the job of resisting this flattening.

Women quite often experience plantar fasciitis during pregnancy. This is due to carrying the extra weight of a baby and the production of a hormone called ligament relaxing hormone. This is made towards the end of the pregnancy for the purpose of relaxing the ligaments around the pelvis in preparation for child birth. However, it doesn’t just affect the ligaments around the pelvis but also the ligaments in your whole body including the feet. This, coupled with being heavier than usual, causes your arches to flatten. They do not automatically return to their previous height which can cause the feet to remain flat thereafter. Wearing an orthotic support during the last half of each pregnancy can be protective of causing this ongoing foot problem.

Foot structure

A flat or pronated foot is longer than one with a high arch. Therefore, the plantar fascia of a flatter foot will be stretched over a longer distance than it is in a normal or high arched foot. This puts tension and an elongation / pull through the tissue of the fascia and through the bones that it attaches to. At these attachment points, inflammation can occur and this will cause pain, usually underneath the heel or in a longways stripe through the arch. Tight calves can also be a major factor in moving too much stress onto the plantar fascia.

Occupation

Occupations that involve being on your feet all day, whether it be standing still or walking around, increase your likelihood of getting plantar fasciitis.

Surfaces

The types of surfaces that you stand, walk and run on can affect your feet. Hard surfaces especially concrete and tile floors will not compress when you walk on them. This leaves your body to absorb the shock of your feet hitting the ground internally, through your bones, ligaments and muscles. This is in contrast to standing or walking on carpet or grass where there is a slight compression of the surface underneath the foot.

Shoes

Poor footwear choices can contribute to the likelihood of developing plantar fasciitis. Wearing absolutely flat shoes, including thongs and ballet flats, is the main culprit. Other footwear risk factors include the hardness of the sole of a shoe, an improper fit and how much support the shoe provides for your foot.

Activity Level

The beginning of plantar fasciitis is often associated with a change in physical activity level. This is usually either an increase in the amount of exercise or a change in the type of exercise. Sometimes, it is not actually exercising that may cause the pain. People with plantar fasciitis often complain of pain when pushing a heavy weight uphill, for example a shopping trolley up a ramp, and when walking on sand barefoot along the beach.

What to do next:

If you have plantar fasciitis, seek treatment from a podiatrist sooner rather than later as the condition can be harder to manage when it becomes chronic. At our Podiatrist Brisbane clinic, we can offer immediate pain relief as well as long term correction. It is anticipated that we can halve your pain level within an hour of your first treatment by using an inexpensive bracing technique to reduce the pull on the fascia. So, don’t delay, seek treatment for plantar fasciitis today.

Achilles Tendon and Calf Pain

Why does calf pain occur ?

The calf muscle is comprised of two separate muscles, the big belly muscle on the upper half of the rear of the leg called gastrocnemius and a broader flat muscle that lies deeper inside called soleus. These have both the muscular component that you can tighten by flexing and a tendinous part.

The Achilles tendon begins just under the belly of the calf muscle and goes all the way down to attach to the back of the heel bone.

The calf muscle is longest when the foot is in a straight position.

When the foot is perfect, every step you take uses the calf muscle to the full, normal length. When the foot is not perfect, usually when it is rolled in or pronated, the muscle doesn’t get stretched all the way out often enough and becomes shortened. When you need to get more length out of it (for example, to walk barefoot, run or walk more quickly or to walk uphill) the required length isn’t there and Achilles or calf pain occurs.

Pain can occur anywhere within the two muscles or the Achilles tendon but happens most often in the cord just above the heel bone or in the medial (big toe side) belly of gastrocnemius.

Things you can do:

There are ultimately only two things that make this better. You can either lengthen the muscle or stop asking it to do movements that it can’t do. Assuming that you don t want to sit down for the rest of your life, some effort will be required to stretch this muscle out. See the diagrams below of the two stretches you will need to do regularly. Doing only one generally won’t work. It is very important to do these exactly right as your body will try to cheat and avoid stretching the muscle. Use the diagrams, keeping the following points in mind.

  • Put all of your body weight on the back leg and push the heel into the floor.
  • Don‘t let your arch sag in. Keep your foot pointing directly at the wall. Keep your knee pointing directly at the wall and over the top of your foot. This is where your body will try to cheat by pivoting away from these positions.
  • Don‘t bounce, get into maximum stretch position and hold it there for 20 seconds. There are four exercises to do, two on each leg. Doing them five times each will take you six minutes. This will seem like a long time!
  • The exercise will hurt when you get it right. When the stretch causes pain in the place where you are complaining of pain, that is where you especially need to be.
  • You can stretch before you do an activity which will generally make it less painful to do. You can stretch during or after an activity which will have more long lasting effects. For best results, do both.
  • The two stretches below are the same except that the first diagram shows the rear leg bent at the knee and the second shows the rear leg straight at the knee.
  • Wear lower heeled shoes most of the time, about 1 cm thicker at the back than at the front is ideal. To avoid pain for a particular activity, add a bit of height to the heel around 2-3 cm is ideal. This could include a thicker jogger or a pad under the heel in your existing shoes. Don t do this all the time though, as it will ultimately make the problem worse.
  • Don’t bother pulling your foot backwards to feel a stretch . The thin muscle on the front of your leg is no match for the much bigger calf muscle and can’t overpower it.

What the podiatrist will do:

The first thing the podiatrist will do is check that the diagnosis is correct. There is another disorder called intermittent claudication that can be confused with this. If you have a history of heart disease or artery problems, ask your doctor for that sheet also or come to see us directly.

The podiatrist will tell you to do these exercises and check that they are being done correctly. A heel raise for shoes will often be provided to you and strapping may be applied. These are the things that will get you feeling better quickly. In cases where calf pain has been present for some time Extracorporeal Shock Wave Therapy may be utilised.

Most importantly for the long term though, is to assess foot position. If it is found that a fault in the foot is to blame for the shortened calf muscles, it should be fixed by way of a functional orthotic device. The alternative is to need to do the stretches forever to keep the pain away.

Straight and Bent Leg Stretches

What are heel spurs? Why did I get a heel spur?

X-Ray View of Heel Spur

The cause of heel spurs is the inflammation of a thick band of gristle that runs long ways through the arch called the plantar fascia.  This commonly occurs at the point of attachment to the calcaneus /  heel bone. At this point, the tissue splits up into 10,000 fibres, each of which punctures the bone to hang on.  This anchor point is called an aponeurosis. When your arch lowers (usually because of a foot malfunction called pronation) the distance between the heel attachment and the front attachment gets longer and the fascia gets put on stretch. A fascia is a type of tissue that has a lot of reticular fibres and not a lot of elastin fibres.  This means it is a ‘steel cable’ not a stretchy one.  Over time, if there is too much stretching tension, the bone will try to ‘help’ by growing forwards to decrease the span of the arch.

This is a heel spur or calcaneal spur. When seen on an x-ray, a spur looks very pointy and most people think that it is standing on this sharp thing that hurts. In fact, the spur pokes forwards not downwards and doesn’t come anywhere near touching the ground. Heel spur pain seems to the sufferer like it is brought on by pressure up from the ground and, while poking the heel can bring on the pain, the problem is different. The pressure is actually longwise through the arch.  It is this elongation pressure that causes the pain and causes the spur to form.  This is an important concept.  The pulling causes the pain.  The pulling causes the spur but the spur does not cause the pain! This is why the pads available in the chemist shop etc that merely cushion the heel, do not work.  They provide a slight benefit by lifting the heel off the ground (which we will discuss next) but a heel spur is ultimately an arch problem, not a heel problem.

What should I do when the heel pain goes?

Plantar fasciitis is an elongatory condition

If you have read the above questions, you will be aware that fasciitis comes about because of a mechanical fault within the foot and that it has an episodal nature – that is, heel pain naturally comes and goes over time.  Episodes can last for many years and tend to get more frequent and more severe with advancing age. After visiting the podiatrist and successful resolution of the pain, it is in your best interests to continue to wear the shoe insert that was provided to you to prevent a re-occurrence of the pain.

Pregnancy and Feet

Pregnancy and Feet

Leg and foot pain is experienced by many women during pregnancy, especially during the last trimester when your baby bump is getting bigger. The most common issues associated with leg and foot pain include plantar fasciitis (heel or arch pain), swelling, varicose veinaroonies and cramping.

Plantar fasciitis 

Pregnant women often experience heel and arch pain, which is known as plantar fasciitis. Plantar fasciitis occurs when there is extra strain put on the plantar fascia, a band of connective tissue that runs long ways across the bottom your foot. During pregnancy this is due to two main factors: the release of a substance called ligament relaxing hormone and the weight gain that is an inevitable part of pregnancy.

Towards the end of pregnancy a hormone called ligament relaxing hormone is made in order to relax and stretch the ligaments around the pelvis to prepare for child birth. This also has an effect on the ligaments that hold the many bones in the foot together. As this decreases the structural integrity of the foot, the bones are now able to move slightly further apart allowing the arch to flatten. As the arch flattens the plantar fascia is stretched across a greater distance.  It can become irritated and pull on its attachments to the bone. This causes the pain that is felt in the arch and bottom of the heel bone.

The arches of your feet may not return to their previous height after pregnancy but wearing an orthotic device during the last half of a pregnancy can both reduce or eliminate foot pain and also be protective of ongoing foot problems after pregnancy.

Should I wear a plantar fascia night splint?

Night Splint

This intervention is almost never required. You may recall that this kind of heel pain occurs when the fascial band is subjected to an excessive stretching force. This traumatises the ‘enthesis’, the place where the band splits up into thousands of  individual fibres, puncturing the bone to take their attachments. Almost always, it is the pronated / rolled in / dropped arch foot type that leads to this elongation.  As the arch lowers, the fascia band pulls tight.  This happens because the start and end points move away from each other.  This ‘stretches’ the tissue until the fibres start to tear which obviously causes the pain. This tissue is subjected each day to this excessive stretching force.  If the (very strong) retinacular fibres that make up this tissue can withstand this stretching force for 10,000 steps you take  every day under the full load of all of your body weight, it should be obvious that the gentle stretch afforded to the foot with virtually no weight applied to the stretch  won’t have any effect.  If the retinacular tissue could stretch, the foot flattening during walking is exactly what would make it happen.  So night splints and plantar fascia socks are not, in my opinion, of any benefit in plantar fasciitis.  Indeed, they often just make it more angry.

Heel Spur, arch pain & plantar fasciitis

The plantar fascia is a thick band of gristle that runs from the heel to the ball of the foot, just behind the big toe. Unlike a tendon or a muscle, the fibres that make up a fascia are completely non-stretch.

When your foot is sitting properly, the band stretches across the arch, travelling a particular distance. Looking at the line drawing below, you can see that both triangles have the two upper arms of the same length. The more arched one has a shorter bottom arm. The same is true in the foot.

If the arch of the foot drops (flatfoot, pronation, dropped arches) the distance that the plantar fascia has to cross increases. Because the band cannot stretch, it will pull on its weakest attachment. For most people this is directly under the heel. It can also be around the rim of the heel or through the arch. The area becomes inflamed and, if present for long enough, the body may lay down extra bone to try to bring the two attachment points closer together. This is called a heel spur. It is important to know that a heel spur does not cause the pain. It is the pulling that causes the heel spur to grow and the pulling that causes the pain.

A heel spur almost never needs to be cut out and surgery is very rare these days. Also, pads commonly for sale to cushion the heel are not useful, as the problem is not downward pressure on the heel (although it feels like it is) but elongation pressure along the length of the foot. 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.

When pain occurs in the heel, your body will often recruit a muscle running from the front of the shin bone to the midpoint of the inside edge of the arch (shown in the diagram at X) to reduce pressure on the fascia. This can result in pain in either of these areas.

What can be done for it?

The key to eliminating the pain is to reposition the foot so that the arch is normal again. This can be done in a simple way if the problem is recent or mild, or a more potent way for worse problems.

In assessing you, the podiatrist will discuss these options with you. If one method is clearly better for you, it may be that a decision is made on how to progress at the first meeting. If there is doubt about how much intervention is necessary to get better, the two approaches can be trialled in temporary form over a week to get a very good idea of likely outcomes.

Steroid injection may be used as a last resort as, although effective, it is quite painful and ultimately weakens the tissue making the problem more likely to recur in the future.

What is causing my heel pain? What is plantar fasciitis?

Anatomy of the Plantar Fascia.

The most common cause of heel pain is called plantar fasciitis. The plantar fascia is a thick band of gristle that runs from the heel to the ball of the foot, just behind the big toe. Unlike a tendon or a muscle, the fibres that make up a fascia are completely non-stretch. When your foot is sitting properly, the band stretches across the arch, travelling a particular distance.  Looking at the line drawing below, you can see that both triangles have the two upper arms of the same length.  The more arched one has a shorter bottom arm.  The same is true in the foot.  If the arch of the foot drops (flatfoot, pronation, dropped arches) the distance that the plantar fascia has to cross increases. Because the band cannot stretch, it will pull on its weakest attachment which for most people is directly under the heel.  It can also be around the rim of the heel or through the arch.  The area becomes inflamed and, if present for long enough, the body may lay down extra bone to try to bring the two attachment points closer together.  This is called a spur.

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. Spurs almost never need to be cut out and surgery is very rare these days. Also, pads commonly for sale to cushion the heel are not very useful, as the problem is not downward pressure on the heel (although it feels like it is) but elongation pressure along the length of the foot. 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.

Is my plantar fasciitis spreading up my leg ?

Plantar Fasciitis and Leg Pain

Plantar Fascia

When pain occurs in the heel, your body will often recruit a muscle running from the front of the shin bone to the midpoint of the inside edge of the arch (shown above at X) to reduce pressure on the fascia.  The muscle gets overworked by trying to create an unusual method of walking and this can result in pain in either of these areas. The same thing could well happen for any painful foot problem, such as standing on a piece of glass and can affect you all the way up the leg, knee, hip, back etc. The podiatrist can address these secondary problems too, but obviously the underlying cause needs to be sorted out.

Why does plantar fasciitis last so long? How long does plantar fasciitis last? Why won’t my plantar fasciitis go away? Why won’t my heel pain go away?

Heel Pain & Plantar Fasciitis

The cause of plantar fasciitis is the inflammation of a thick band of gristle called the plantar fascia.  This commonly occurs at the point of attachment to the calcaneus /  heel bone. At this point, the tissue splits up into 10,000 fibres, each of which punctures the bone to hang on.  This anchor point is called an aponeurosis. This zone has very, very poor blood flow.  If you were to cut the area surgically, you would squeeze out a couple of drops of blood but nothing like what would flow by cutting skin, bone or muscle. Plantar fasciitis is an episodal condition which means that, if you are prone to it, you will suffer episodes or ‘attacks’ on and off through your life. An episode might last a month or it could well last five years.

For this reason, doctors will often say “Don’t worry, it will go away by itself” which 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 ‘bounce’ the collagen in your connective tissues becomes.  This is the reason you get wrinkles as you age and is also the reason why attacks of plantar fasciitis get more severe and more frequent as you age. For this reason, you will see that your life will get better and stay better if plantar fasciitis is treated early and effectively.  This is achieved by use of a shoe insert and it is best to continue using the support for the long term to avoid further episodes.  The inserts are discussed in these questions but are much more user friendly now than they have been in the past.

Shoes / footwear and heel spurs / heel pain / plantar fasciitis

Bilateral heel spurs

Some sorts of footwear will definitely make plantar fasciitis worse. The two attributes are primarily flatness and a long way second, hardness.  Shoes that are dead flat such as thongs, ballet flats, slippers, men’s fashion shoes that look like ten pin bowling shoes, soccer boots (and no shoes at all) are the worst possible footwear to choose.  If you examine your footwear and subtract the thickness of the shoe at the ball of the foot from the thickness under the heel, you want the heel to be thicker by about the breadth of your thumb. This will help a lot just by itself.  You would prefer then to pick a shoe with sole material with some bounce to it.

Many people do not like to wear shoes in the house but if you suffer from plantar fasciitis, you really have very little choice.  Additionally, you are very likely to end up needing orthotics in your shoes – including your house shoes.  If you are in a hot climate, consider buying a pair of CrocsÔ shoes as these will still be of use if you end up with orthotics.

Orthotics and Plantar Fasciitis / heel pain / heel spurs

Bony plantar fascial spurHaving read the above passage about the cause of plantar fasciitis, you will now be aware that it comes about because of a mechanical fault within the foot.  The fasciitis may come and go over time but the foot fault is permanent.  To ‘correct’ this, a podiatrist will often make a pair of arch supports called orthotics.  Sometimes a lesser sort of insole will be sufficient, particularly if the problem is mild, recent or if the sufferer is quite advanced in years.

 

How long will I take to get better / recover from plantar fasciitis?

How Long will It take to recover from plantar fasciitis


Firstly, a diagnosis will be reached.  Secondly, treatment options will be discussed and thirdly treatment will be commenced if you elect to do so. One additional step that we can perform is to apply a particular kind of taping to the foot.  This taping binds the two ends of the arch together into a shortened position.  This will take the tension off the fascial band immediately. The response in treatment does vary for everyone but it usually will reduce the pain by 50% within half an hour.  When the tape comes off three days later though, the pain will return with the same speed that it left. This brings us to an interesting point that has implications down the track.  Specifically that the pain can be relieved even when the problem isn’t actually resolved at all. Usually, orthotics will be ready for you in about a week, during which time you may elect to be taped up again.  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.

Our clinic requests that you return in 2-3 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.  However, it is possible to take away the pain without actually solving the problem.  The plantar fascial tissue has very poor blood flow and 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, you will still be able to have some pain.  This is particularly so of first-step pain in the mornings.  You should try hard not to experience pain for two reasons.  Firstly, pain hurts! Secondly, pain means damage is occurring.  Too much pain (i.e. re-injury) will slow down your healing unnecessarily.

Plantar fascia stretches ? Stretches for plantar fasciitis ?

Reticular fascial fibres are very strong.

Frequently we are asked how one might stretch their ‘tight’ plantar fascia.  First, let’s recap on why plantar fasciitis occurs in the first place.  This kind of heel pain occurs when the fascial band is subjected to an excessive elongatory force. This traumatises the point where the band splits up into 10,000 individual fibres which puncture the bone to take their attachments. Almost always, it is foot pronating / rolling in / dropping arches that cause this to happen.

As the arch lowers, the fascia pulls tight because the start and end points move away from each other.  This ‘stretches’ out the tissue until the fibres start to tear. This tissue is subjected day to day to an excessive stretching force.  If the (very tough) retinacular fibres that comprise this tissue can withstand this stretching load for all the steps you take each and every day under the full load of your body weight, it should be obvious that 10 minutes of extra  ‘stretching’ per day won’t have any effect.  If that tissue could stretch, foot pronation is exactly what would make it happen.  So, to boil it all down, stretches are not of any benefit in plantar fasciitis.  Indeed, they will often just make it more angry.

Should I get an X Ray of my foot if I have plantar fasciitis / heel spurs?

Heel Spur

When you come to see the podiatrist, it is generally not required to have an x ray for heel pain.  Although a spur may be present on your foot – which gives plantar fasciitis its more common name  of ‘heel spurs’ – it is not very relevant to the treatment. To briefly recap, plantar fasciitis comes about when the pulling / elongation strain on the band is too great and it starts to tear.  Now, although the spur looks sharp and pointy – and although it might feel like you are standing on an icepick in there – this is not really the case.  Look at the adjacent x ray and you will see that the spur points forward in line with the fibres of the fascial band.  It doesn’t point down. Ultimately, it all comes down to this:  The pulling causes the pain, the pulling causes the spur, the spur does not cause the pain. Plenty of people have spurs and no pain and plenty have pain and no spurs.  If we have an x ray of your foot and you have a spur, we will tape you for immediate relief, discuss footwear choices and probably recommend orthotics.  If we have an x ray of your foot and you don’t have a spur but do have plantar fasciitis ?  Guess what ?  The treatment is exactly the same.  Unless the condition is complicated in any other way, the podiatrist won’t generally require x rays.  Indeed, useless x rays cost you and your community a lot of money and irradiate your body for no good reason. If we do want them for some reason, we usually like to be very specific about what shots we want so it is best to visit us first and don’t go out of your way to get films taken before your visit.  If you already have them though, do of course bring them.  They can be useful to count in or out other more complicated conditions and we can run through them with you to explain just what is going in.

Shoes for plantar fasciitis

Shoes for plantar fasciitis

As podiatrists, a very common question we are asked is “what shoes should I wear to help my plantar fasciitis?”. We will talk about shoe selection in a moment but it is important to note that shoes alone aren’t the answer to the treatment of plantar fasciitis. Understanding why plantar fasciitis occurs is the first step in understanding what features to look for in a shoe.

The plantar fascia is a strap that tethers the front of the foot to the back, and is essential in holding up the arch of the foot. As we walk and the foot spreads out, there is tension applied and the band becomes “loaded”. Plantar fasciitis occurs due to excessive and repetitive loading of the band during day to day activities such as walking and running. By supporting this band with footwear, the strain on the plantar fascia can be reduced.

The peak load on the band occurs when you begin the lift the heel from the ground during gait. The first centimeter or so of the lift is the most physically challenging for the plantar fascia. By wearing a shoe with a small (8-12mm) elevation to the heel, this hardest phase can be avoided.  Therefore, choosing a shoe with an adequate heel height is an important consideration when choosing shoes, not only for exercise, but also for day to day activity.  Flat shoes, such as fashion sneakers and ballet flats are a bad choice if you suffer from plantar fasciitis.

Another important load time is when the forefoot hits the ground and the fascia has to go from being slack to being taut.  Just like a crumple zone on a car, if this loading of the band can be spread out over a longer time, the ‘yank’ (peak force) applied by the loading is reduced.  This translates to looking at the density of the shoe.  In general a softer, more cushioned shoe is better than a hard shoe.  Shoes that are really soft – can in fact be too soft.  The material of the sole needs to deform, but with resistance, to effectively slow the elongation of the plantar fascia band.

Another good feature to look for, especially in running shoes, is a dual density midsole. This is a denser area under the inside ankle bone and is commonly found in good brands of joggers. It changes the dynamics of the foot to create a soft touch down on the outside of the heel and firmer resistance on the inside to help hold the heel in a more vertical position, slow the band elongation and to support an orthotic device.  Even if you do not currently wear orthotics at the moment, if you have plantar fasciitis, it doesn’t hurt to plan ahead in case orthotics are required to treat your pain.

Generally good brands of casual shoes include Vionic, Keens, Revere, Zierra, Orthaheel, Naot and Merrell. We suggest avoiding the use of all flat shoes, including ballet flats, standard thongs and “barefoot running shoes” as they are too flat, provide no support for the plantar fascia and increase the strain on the band at the point of heel lift.  This is so important that if all other things in the lower limb are functioning equally, a hard shoe with a 12mm heel raise would be a better choice than a soft, super flat style of shoe.  Keep a pair of shoes with an adequate heel height and some arch support beside the bed to reduce the pain of the first few steps on rising.

Whilst getting the right shoe is important, you may need to consider orthotics to treat the condition. Orthotics can effectively turn nearly every shoe into a ‘good’ shoe and therefore can be cheaper (as well as more effective) than buying a whole collection of ‘orthopaedic’ type supportive shoes.

Treatment Options

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.

Strapping

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

Orthotics are required to resolve the condition for most people.  This is because the underlying cause of fasciitis is 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.

Shockwave Therapy

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 plantar fasciitis (ESWT, Extracorporeal shock wave therapy, Lithotripsy)

Local Injection

The podiatrist can administer an injection deep into the plantar fascia, allowing a reduction in the pain as well as any abnormal tightness or thickness over a course of 2 weeks to 1 month. 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.

Wouldn’t it be nice to Walk Without Pain?

Plantar Fasciitis Brisbane Clinics.

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