Heel and arch pain – Plantar fasciopathy: Adelaide physiotherapy
By Vital Core Physio Elizabeth Santos
What is it?
Plantar fasciopathy is the most common cause of heel pain. It used to be called “fasciitis” as it was thought to be primarily an inflammatory condition. Treatment used to focus on ice and rest to treat the so-called ‘inflammation’.
Research over the last 20 years has shown that it is in fact a ‘degenerative’ condition, which means that more load/stress has been applied to the soft tissue around the heel and arch (Particularly the Plantar Fascia) than it can cope with.
When any tissue in the body is subjected to more load than it can manage, compensatory mechanisms will take place. In the foot, this can include formation of a small pockets (3-4mm) of failure in the fascia (tissue through the arch) referred to in scans as ‘tears’ as well as swelling and pain. In longer term plantar fasciopathies it can also cause the formation of strange nodules and bone spurs.
Who is at Risk?
It commonly affects physically active people such as recreational runners/ hikers or people who work with large amounts of standing (particularly on hard floors). Spring and summer are common times for plantar fascia to occur as we all start wearing thongs or other poor quality/ unsupportive footwear (thongs and crocs are the enemy).
In recreational runners or athletes, it has been linked with knee alignment, foot posture and most importantly increases in training load. You can read more about running injuries here.
Decreased mobility and / or strength in the ankle, knee and hip can contribute to this condition as it alters the patterns of movement potentially over loading the plantar fasciopathy.
People with plantar fasciopathy commonly present with pain of gradual onset that is felt over the inside aspect of the heel and may radiate through the arch or into the heel itself.
It may also begin suddenly with a recent increase in physical activity or training load.
Most people report that it is worse in the morning when getting out of bed (we call this ‘first-step’ pain). The pain usually settles with walking once you get on with your day, but can return after activity and might ache after a longer walk or run.
Periods of sitting and feeling ‘pain free’ might be followed by pain once you resume activity or walking again.
If the condition worsens, the pain may be present when standing and worsen with activity. Some people also experience pain that isn’t related to weight bearing, such as aching when they are lying in bed at night.
The pain can vary from sharp stabbing to a dull ache and pain may spread to other areas of the foot or lower leg if other structures become involved. Sometimes this is a sign that your body is compensating and trying to adjust itself to relieve load on the painful tissue.
Walking in bare feet or unsupportive shoes (such as thongs or crocs) can aggravate the symptoms.
What Does Physiotherapy Assessment Involve?
Being properly assessed by your Vital Core physiotherapist is the essential step in the right direction and the sooner you do this the better!
The first step in the assessment process is determining what your goals actually are. Do you want to be able to run a half marathon? Do you want to be able to walk around the block each day with your dog? Do you want to be able to wear those awesome heals to your end of year party? The reason to get better needs to be more than “just not hurting” because (unfortunately) pain is the LAST symptom to present and the FIRST symptoms to go. So if we only treat to when the pain seems to be ‘gone’ you will be back in the clinic again in a short period of time because it will be back again. This is why at Vital Core we ask so many questions at your assessment.
Your physiotherapist will also assess:
- Your walking (gait)
- Ergonomic/Occupational positions
- Muscular weakness/dysfunction
- Foot mechanics in walking and running
- Lower limb muscular imbalance
- Exercise choices / techniques
- Lumbopelvic muscle imbalances
- Any other contributing factors or pre-existing injuries
- Whether further Investigation is required
- Whether referral to one of our preferred podiatrist is required
With this assessment and an understanding of what is important to you, the Vital Core team will structure a comprehensive treatment plan that will get you 100% better (not just the pain gone) and achieving your goals.
What Does Vital Core Physiotherapy Treatment Involve?
Once we have a clear picture of your goals and diagnosis we will structure a treatment plan. Typically there are three main phases of the treatment plan;
1 – Pain reduction (remember this is the last symptom to present and the first one to go).
2 – Functional rehabilitation – building up the load tolerance of the plantar fascia and addressing all other dysfunctions that lead to the onset of problems.
3- Preventative and maintenance – This is the ongoing work that we need to do to stop it coming back.
Treatment plans take time. A massage of your foot and a couple of stretches will not ‘fix’ plantar fasciopathy. It won’t be ‘fixed’ in a week or two. Sorry. But we will get your moving and feeling positive about your rehab straight away.
You will likely need a combination of the following modalities to get the best results:
- Ankle / Foot joint mobilisation
- Soft tissue massage / deep tissue massage
- Taping – we can teach you how to do this.
- Customised foot/ arch supports (or referral to our trusted podiatrist colleagues)
- Stretching/ calming of tight or over active muscles
- Strengthening of weak muscles
- Home exercise program including the use of the spiky ball
- We will include a progressive exercise plan focusing on technique and control at all times and may recommend one our many exercise classes (see our timetable).
Here is a video showing how you can manage foot pain at home. The spiky ball for foot pain
It’s really important to start treatment early to ‘nip it in the bud’ and ensure it doesn’t worsen – (which can be painful and inconvenient!)
When you commit to getting 100% better you can work closely with your Vital Core physiotherapist towards preventing recurrence in the short and long term and get you back to living your goals.