In my 'There's nothing wrong with me' blog I mention that prior to leaving Melbourne I had an onset of major foot pain, I couldn't even put my left heel on the ground it hurt that bad. I was lucky to find Jesse at the Prahran Foot clinic. His friendly and loving demeanour, alongside his way of talking you through the issues and treatment (wealth of knowledge this man) make him a keeper in my opinion. I've already referred three patients his way, all with good feedback! So I asked Jesse to be part of my Guest Post series.
Heel pain caused by plantar fasciitis is a common yet often debilitating condition that can seriously impact your lifestyle if not treated effectively and quickly. Typically we will see around two presentations of plantar fasciitis per day at our practice. Thankfully, the majority of cases resolve using simple conservative therapies.
First, some basic anatomy. The plantar fascia is a thick band of connective tissue that runs from it’s insertion point at the inner tubercle of the calcaneus (heel bone) and attaches further down in the forefoot. A local nerve branch that travels down the inside of the heel and over the insertion site is responsible for transmitting the pain. We say that the plantar fascia helps support the arch of the foot, but we’re not really sure - if you sever it surgically or traumatically normal foot function remains - furthermore it will just grow back and reattach in 6 weeks! It is normally quite tight, and it is excessive tension on the plantar fascia is what eventually causes strain near the insertion point, resulting in the heel pain. Pain is different for each individual, but commonly starts to occur during the first few steps in the morning, then it can creep back in the afternoon, and eventually in more established cases pain can be present all day. Pain severity can range form a niggling tightness to a debilitating, limping pain.
Identifying the underlying cause of this excessive tension is key to resolving the pain. In most cases, poor ligament structure in the foot is the cause. This causes pes planus, commonly referred to as flattened arches/flat feet/pronation, which puts strain on the plantar fascia. Surprisingly, another common cause for calcaneal rotation is tight gluteal muscles, which of course attach to the back of the calcaneus via the achilles.
I like to separate treatment into two categories - treatment aimed at fixing the pain, and treatment aimed at fixing the cause.
Treatment aimed at resolving pain;
Morning pain: A great way to get rid of morning heel pain is simply sit on the edge of your bed before you get up and roll a golf ball under the affected foot. This makes your gastrocnemius muscles contract and pump fluid from your foot and around your body.
Afternoon pain: Using the same principles as with morning pain, a coke bottle filled with water and frozen will reduce pain when rolled under the foot
Strapping: Strapping tape applied by a Podiatrist and left on for 5 days will greatly reduce pain by taking pressure of the plantar fascia
Medication: Oral paracetamol and non steroidal anti inflammatories used as directed will work to reduce symptoms.
Treatment aimed at resolving the cause;
Orthotics: Orthotics re-position the calcaneus when used, and work great at stopping plantar fasciitis from getting worse. There are many forms of orthotics (with varying price tags!). Custom orthotics are most effective and can last many years, but are more expensive. Some over the counter devices can work, but tend to be bulkier and not last as long. A simple rule is the harder the device, the better! Don’t go for soft cushioning devices, they won’t hold your foot up!
Stretches: A simple calf stretch can save the day, if you are diligent. Remember the gastroc muscles causing calcaneal rotation? Performing a calve stretch, holding for 30 seconds 3 times per day for 6 weeks will lengthen the muscle and take strain off the calcaneus.
Footwear: By far the most important treatment I can provide is tell me patients to buy good shoes. They need not be expensive with gimmicks, simply firm shoes. Pick up the shoe and try to bend it in half - if it resists strongly and doesn't bend, good start. Push the back of the heel down - if it doesn’t flatten, get it. It is no exaggeration to say that you can buy top of the range custom orthotics for hundreds of dollars but with bad shoes you almost certainly won’t get better! Just remember, good shoes are good treatment.
If these conservative treatments don’t help, it’s time to see a Podiatrist. Many other treatments are available, form cortisone to night splints. Rest assured that in my experience more than 90% of cases will resolve if all of the above are carried out.
Prahran Foot Clinic is located just of Chapel street, Melbourne (Coles and Safeway car-park) at 5 Izett Street Prahran Victoria 3181.
I highly recommend if you have any foot concerns to make an appointment with Jesse.