Don’t feel de-FEET-ed by a “heel spur”

Plantar fasciitis, otherwise often referred to as “heel spur” is very common. Around 10% of people will suffer from plantar fasciitis in their lifetime.

Yes, that’s right 1 in 10.

“Heel spur” also accounts for around 11-15% of all adult foot problems that require medical help.

To understand this condition we first need to understand the anatomy behind it.

The plantar fascia is a thick and fibrous band that extends from the bottom of the heel to the ‘knuckle’ aspect of each toe.

It comprises of 3 dense connective tissue sections which help with pushing off the big toe, reinforces the foot arch and absorbs impacts to the heel when walking or running.

Plantar fasciatis often presents as pain, sharper with the first steps in the morning or after a long period of rest, or after extensive walking. Plantar fasciitis affects both elite or recreational athletes. So if you’re a “weekend warrior” you may get it too.
Interestingly, women are affected slightly more often than men. The location of pain is mostly at the bottom of the heel and can cause pain around the heel, foot arch or even the base of the toes.
Things that put you at risk of getting this condition are:

  • poor foot positioning such as flat feet or high arches,
  • being overweight (obesity contributes to about 70% of all plantar fasciitis cases),
  • muscle tightness/weakness,
  • reduction the thickness of the protective heel fat-pad,
  • incorrect training progression and
  • incorrect footwear.

If you’d like to understand the complexity of what actually happens when you have a plantar fasiitis… here it is. In a nutshell this condition is usually brought about by a repetitive strain that seems to cause micro tearing in the plantar fascia. This is followed by thickening of the connective tissue along with the destruction of elastic-like collagen.

When one looks up the treatment of plantar fasciitis on ‘Google’, one can come across a myriad of treatments and intervention. Some of these treatments have very little credibility or scientific evidence behind them. So this is definitely not a strategy we recommend.

To clarify this matter a big systematic study review was carried out in 2014 to identify the most effective form of treatment. The research divided the treatment modalities from most to least effective. The most effective was awarded an ‘A’ grade with the least being given a ‘D’ grade.

This research found that the most effective modalities were manual therapy consisting of joint and soft tissue mobilization of the relevant lower extremity as well as stretching the calf muscle.

And this is generally how we approach plantar fasciitis problems here at BodyFit Physiotherapy Howick & Pakuranga. We also use the proven-to-work plantar fasciitis exercises to speed up your recovery. One study showed that heel pain was either eliminated or much improved after 8 weeks in 52% of patients who were treated with an exercise program to stretch the plantar fascia.

Furthermore, taping, foot orthoses and night splints were all classified as grade ‘A’.

In fact, one study found that the combination of foot orthosis and a night splint resulted in a 47% reduction in pain.

The use of ultrasound and shock wave therapy were classified as ‘C’ grade. And finally, electrotherapy such as the use of TENS machines was classified as ‘D’ grade evidence.

On a side note, there is limited evidence supporting the effectiveness of cortisone injection as a first-line intervention for heel pain/plantar fasciitis, because the benefits do not outweigh the risk of harming the plantar fascia further.

Cortisone injections may only be used after conservative treatment has failed; however, with respect to other injection modalities, botulinum toxin injections appear better than corticosteroid injections and corticosteroid injections are better than autologous blood injections. If such interventions fail then surgical option is then considered. Generally, partial or complete surgical intervention is recommended after 6-12 months of ineffective conservative treatments. It is generally rare to see surgery done for a plantar fasciitis pain.

Unfortunately, the complete recovery from plantar fasiitis symptoms is a very long process, which at times may take up to two years. Thanks to hands-on physiotherapy therapies, about 85-90% of people with plantar fasciosis can be successfully treated. The main thing is to stay positive and celebrate the small victories.

Another study found that 27% of cases of plantar fasciitis had been misdiagnosed. Just because you have heel pain doesn’t mean you necessarily have a heel spur or plantar fasciitis. Other common causes of heel pain are ligament tears and plantar fibromas. That’s why seeing a health professional is crucial.

If you have heel pain feel free to book in for a FREE Physiotherapy assessement at one of our clinics: Howick or Pakuranga. Simply call 09-5328942 or fill in the quick-and-easy form on the top-right.

Written by Shawn Lawyer, Physiotherapist at BodyFit Physiotherapy Group in Howick and Pakuranga, Auckland

 

References:

DeMaio, M., Paine, R., Mangine, R. E., & Drez, D. (1993). Plantar fasciitis. Orthopedics, 16(10), 1153-1163.

Lee, W. C., Wong, W. Y., Kung, E., & Leung, A. K. (2012). Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis. The Journal of Rehabilitation Research and Development, 49(10), 1557. doi:10.1682/jrrd.2011.09.0181

Buchbinder, R. (2004). Plantar Fasciitis. New England Journal of Medicine, 350(21), 2159-2166. doi:10.1056/nejmcp032745

Rosenbaum, A. J., Dipreta, J. A., & Misener, D. (2014). Plantar Heel Pain. Medical Clinics of North America, 98(2), 339-352. doi:10.1016/j.mcna.2013.10.009

http://www.japmaonline.org/doi/abs/10.7547/0003-0538-105.2.135

 

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