Heel Pain (Plantar Fasciitis)

Introduction

Heel pain is a very common problem that may be attributed to several etiologies, including heel spurs, plantar fascia irritation (acute or chronic), and bursitis. Plantar fasciitis is thought to result from microtears in the fascia due to repeated biomechanical stress on the arch of the foot on weight-bearing. Plantar fasciitis is an inflammation of the plantar fascia & the perifascial structures. Chronic stress to the origin of this fascia on the calcaneus may cause calcium to deposit, forming a spur (plantar calcaneal spur).  Plantar Fascia is a Dense, broad band of connective tissue attaching proximal and medially to the calcaneus and fans out over the plantar aspect of the foot and works in maintaining the stability of the foot and bracing the longitudinal arch.

The pain is maximal when the patient first stands in the morning and tends to decrease with walking. Ten percent of people may experience pain under the heel (plantar heel pain) at some time during their life.

Cause

Plantar fasciitis is the most common cause of heel pain in the adult population with an incidence of around 10%. It affects adults across the age spectrum with an incidence in women twice that of men. Ethnicity does not influence incidence. There is a higher preponderance in those who play sport either recreationally or professionally. Increased body weight and an increased body mass index (BMI) have also been shown to be significant risk factors for developing plantar fasciitis. Pregnancy, flat feet, high arched feet, poorly fitting or worn footwear, Calf muscle tightness, gait abnormalities, prolonged standing, running, jumping and walking are additional contributory factors. Excessive lumbar lordosis—a condition in which an increased forward tilt of the pelvis produces an unfavourable angle of foot strike when there is a considerable force exerted on the ball of the foot—can also contribute to this problem. Running on soft surfaces are also potential causes of plantar fasciitis.

Clinical features

• The patient presents with a history of severe plantar medial heel pain typically on initial mobilization after a period of non-weight bearing such as in the morning after getting up from bed or sitting for long periods.
• With further mobilization, the pain often improves but then reoccurs and increases throughout the day with ongoing weight-bearing.
• The diagnosis is usually made clinically with tenderness on palpation of the plantar fascia and pain on passive dorsiflexion of the toe

Assessment

Looking for Swelling, Arches, Deformity, Gait, posture, tenderness, Tight Structures etc & History

Summary

For the treatment of heel pain or plantar fasciitis, research has not indicated any consensus on a specific treatment regimen that has proven to resolve heel pain with any statistical significance. However nonsurgical treatment is ultimately effective in approximately 90% of patients.

It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such as the increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes.

Early recognition and treatment usually lead to a shorter course of treatment as well as an increased probability of success with conservative treatment measures

S.M.A.R.T. approach to prevent plantar fasciitis

The Canadian Physiotherapy Association (CPA)

• Stretch
•  Move
• Add it up
• Reduce strain
• Talk to a physiotherapist

Calf and Achilles stretching is achieved by performing asymmetrical stretching exercises

ANRC Phases of Rehabilitation

Phase 1- Pain Relief (Trigger Point Therapy, Myofascial Release, Sports massage, Taping, Electrotherapy modalities, Postural Correction, Basic Home exercises etc)

Phase 2- Restoration of Range of movement and muscle length (Stretches, Exercises for the small muscles of the foot, Postural training, Basic Strength Training, Orthotics if needed)

 Phase 3- Maintenance Phase & Improve the activity of daily living (Intensive Strength Training, Ergonomic Modifications in Sports & Daily Activities

Reference

1. ABC of Common Soft Tissue Disorders, First Edition. Edited by Francis Morris, Jim Wardrope and Paul Hattam. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.
2. Musculoskeletal Interventions, techniques for therapeutic Exercises, Edited by Barbara J. Hoogenboom, Michael L. Voight, William E. Prentice @ 2014 by McGraw-Hill Education ISBN: 978-0-07-179370-4