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Plantar Fasciitis, a pain in the heel

Plantar fasciitis is a painful condition localised under the heel of the foot, affecting approximately 10% of the population during middle age. 8% of all foot injuries in runners are also linked with Plantar Fasciitis.


Plantar fascia is a thickened fibrous sheet of connective tissue that covers the sole of the foot. It helps to maintain the longitudinal arch of the foot an acts as a shock absorber.


Plantar fasciitis is thought to be caused by too much stress on a weak part of the plantar fascia where it attaches to the heel due to poor biomechanics. Altered biomechanics increases the tension of the plantar facia during weight baring activities such as walking and running. This triggers a chronic degenerative process (wear and tear).


Poor biomechanics can be caused by a number of things such as:


- Prolonged standing

- Running

- Increase in age

- Increase in BMI

- Reduced ankle range of movement

- Tightness of hamstring and or Calf muscle

- Reduced great toe movement

- Over pronation of the foot (flat feet)

- Poor footwear



The main symptom of plantar fasciitis is heel pain noticeable with initial steps after inactivity typically in the morning when you first get out of bed. Also, pain levels normally increase after weight bearing activity.


It is important to get a confirmed diagnosis by a physiotherapist or doctor especially if you have had it for a long time . There are other conditions that mimic the symptoms of plantar Fasciitis. These include; tarsal tunnel syndrome, nerve entrapment and a stress fracture of the heel.


Treatment of Plantar Fasciitis consists of:


- Advice on orthotics and footwear modification. Insoles can correct over pronation. Shoes with structured cushioning can help elevate pressure on the heel.

- Education on how to self tape

- Rehabilitation programme consisting of exercises to increase ankle range of movement, stretching and strengthening exercises and balance exercises.

- Shockwave therapy

On a personal note....


I had my first experience of plantar fasciitis last year around May time. I do have flat feet and spend a lot of my time in wellingtons (even when it is not muddy). I think the ground becoming harder and due to the poor support and shock absorption my boots give my feet, it was enough to trigger the problem. Normally this type of condition bubbles under the surface gradually building up until you begin to notice it.

Even as a physiotherapist I normally take the common approach that if you ignore it and rest a bit it will slowly go away. I was due to go walking in the lake district three weeks after the start of the my symptoms so rest and the wait and see approach was not appropriate. Stretching my calves by dropping my heels down on a step as many times throughout the day as I could became a normal thing at work. I had started to wear my insoles that had been stored away in a draw and designed a 20 minute programme consisting of further stretches, foam roller and strengthening exercises. . I was extremely lucky in the fact I could use the shockwave machine and although very painful it helped a lot.

I managed to complete the walking holiday painfree including climbing Helvellyn and Scafell Pike.

However it is now April again, the ground is getting harder and I have been wearing wellingtons again. I hate running and even when I was younger always tried to get out of it, thought I would challange my self to couch to 5k. Although I swear by my Asics Kayano trainers and Orthosole insoles I need to get back into the routine of stretching. From walking around all winter in poor supported footwear I have every chance of the plantar fasciitis coming back.

As plantar fasciitis is more of a chronic pain from wear and tear of structures I need to remember what is happening under the surface and make sure my biomechanics are optimal before the pain starts to build up to level where it starts to stop me from doing what I enjoy.

Physiotherapists can think we are resilient to injury but in truth we are not!!



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