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Updated: Mar 4

Getting pain in your heel when you get up in the morning or on getting up after being sat down for a while? Drawing pain in the heel or arch of the foot after you’ve been stood up for a while? A burning pain in the foot at night? Pain that is triggered by exercise, improves on exercising and then comes back afterwards?

You may have Plantar Fasciitis, or more accurately, Plantar Fasciopathy; as current thinking poses that pain in the plantar fascia is no longer predominantly due to inflammation of the tissue, and is instead multifactorial.

What is it? The Plantar Fascia is a band of ligamentous-type tissue which joins the heel to the base of the toes. It is there to maintain and support the arch of the foot. Plantar Fasciitis is the term used to describe microtears, and subsequent inflammation, around the Plantar Fascia’s insertion into the calcaneus (heel bone) or along the arch. Microtearing is caused by excessive load on the plantar fasciitis. The pain perceived is secondary to the inflammation.

Plantar Fasciitis

What causes it? This is variable from case to case, but some factors to consider include: - - age - gender - weight; in particular, if you have gained a significant amount of weight in a short period of time (e.g. pregnancy) - prolonged time spent on your feet (either through work or training/exercise) - the surface you spend this time on (e.g. concrete/hard surfaces) - poor footwear (e.g. thin soles, no fastening so foot is not stabilised inside the shoe) - biomechanics (e.g. pronation and tight calf muscles) - commencing a new activity (i.e. taking up running) Differential Diagnoses - arthritis (osteo or rheumatoid) - a calcaneal (heel) stress fracture - tarsal tunnel syndrome - Achille’s tendonitis - heel pad atrophy (loss of fat pad over the heel) - osteomyelitis (infection of the bone; rare) Management Treatment is centred on relieving the symptoms and identifying the underlying cause of the problem.

Relieving the Symptoms R E S T Easier said than done when we’re talking about the feet, but if you continue to weight-bear on (and therefore overload) the plantar fascia, the tissue will continue to tear and the inflammatory cycle continues.

Footwear Modification Chances are your footwear is not cushioned enough. You need shock absorbency. A decent pair of thick-soled trainers or adding a gel or foam insole and/or heel cushion to your current footwear will help. Calf Stretches In most cases the calf muscles (gastrocnemius and soleus) are tight and effectively ‘pull’ on the plantar fascia, contributing to the microtear-effect around the heel and arch. It is important to stretch out these muscles to help relieve symptoms. Healthline has a handy 'how to' guide of stretches to help relieve plantar fasciitis. Icing Use a frozen bottle of water to massage the bottom of the foot; roll the foot over the cool bottle for a few minutes as and when required. This will help to calm the inflammation and offer some pain relief. Massage Massaging the foot encourages blood to the area and can help soothe the pain and settle the inflammation. I recommend using a product such a Tiger Balm® or Voltarol® gel. The Voltarol® has the added benefit of being an anti-inflammatory product which will help to address the inflammation caused by the microtears and allow the plantar fascia to heal. Pain Relief Taking paracetamol and/or ibuprofen can be helpful in the more acute stage to help relieve symptoms. Always read the instructions in the box to ensure oral pain relief is safe for you to take.

Orthotics Heel pads and arch supports may help to offer cushioning and correct over-pronation (‘rolling-in’) respectively. It is best to discuss these with a podiatrist to ensure you are not wasting your time (and money) - and you can also hurt yourself if you start tinkering with your alignment without checking-in with a professional (think knee pain, hip pain, back pain...)

In Conclusion… You CAN rectify Plantar Fascitiis – but you should make sure you have the correct diagnosis before pursuing any management plan.

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