Heel Pain and Plantar Fasciitis

Over the past few weeks, I have seen an increasing number of patients of all ages  complaining of  Heel Pain – usually diagnosed as Plantar Fasciitis (PF).

The pain is usually persistent and occurs under the heel pad and around the heel. Often it only affects one foot, but after questioning and examination, they admit to “a bit of discomfort in the other foot.”

This extremely painful condition also called Plantar Fasciitis (PF), but strictly speaking PF causes pain into the arches and soles too, rather than just the heel.

In 1979, one of the founders of Podiatric Sports Medicine, Dr Steve Subnotnick, devoted an entire chapter to heel injuries, in his book Cures for Common Running Injuries. He was probably the original ‘running foot doctor’ when the surge in road running began to take off worldwide.

Tell me where it hurts!

The pain is usually worse in the morning when taking the first few steps and then gets less with continued movement. This pattern is repeated if you sit for a while later in the day – say in a meeting, classroom, lecture or tea-break – and stand up to walk again.

Patients always point to the exact site of pain. This is right in the middle under the heel pad. On the inside (very common) or outside of the heel and at the back.

Why does Plantar Fasciitis hurt?

Overuse is the phrase we use to explain PF! It’s a bit like saying stress. The basic cause is the malfunctioning of the person’s foot and lower limb structure, what we call your Biomechanics. The normal -for you – rocking and rolling movements are exceeded and the tissues get strained and inflamed at the very point where the plantar fascia is attached to the heel bone.

This can be caused by too much exercise such as increasing your distance and not getting enough rest. Changing the surface you run on; for example: running on a treadmill, starting running without the correct preparation, suddenly running more quickly.

Another common cause as we get older is being overweight.  Or a change of occupation where more walking or standing is required. Old worn shoes for day wear or exercise. Arthritis, a pinched nerve. All these and many more causes need to be identified.

How do you treat Plantar Fasciitis?

With difficulty to be honest! You must let your podiatrist see a good selection of your shoes. Frequently we can provide relief from the symptoms by padding, taping and some anti-inflammatories.

The basis of treatment is the biomechanical assessment to identify what goes on as you walk/run. Orthotics may be necessary, but current therapy is team-based,  so I might send you to a Physiotherapist or Biokineticist for strengthening of other muscle groups in your body.

We talk of core strengthening, to improve posture and alignment above the lower limb. If the pain is at the back of the heel gentle stretching plus raising the heeel helps. Nearly always lifting and cushioning the heel gives some relief. Wearing a higher heeled shoe also helps sometimes.

Can I avoid  it?

Yes, but not always. If you can diagnose the problem yourself then stop doing what caused the PF. We often get heel pain on holiday after a day of sightseeing or playing on the beach or more likely shopping!

Never let your trainers get badly worn, especially if they bulge on the inner side. Keep your weight under control. If you know you are going to have to do a lot of standing or walking, consider wearing your more comfortable shoes and change into your fashionable ones later.

At the first sign of pain seek professional help and advice – a proper biomechanical examnation will identify whether plantar fasciitis is the problem. Remember the basic First Aid of treating any inflammation of the soft tissues of your feet.

• Rest;
• Ice;
• Compression;
• Elevation.

Fitting Children’s Shoes – Again!

Fitting children with shoes can be really difficult and is often unpleasant for all involved. That includes brothers, sisters and fathers hanging around nearby! This means that the responsibility for getting the correct usually lies with Mum. The trauma increases due to the fact that in South Africa, there are virtually no shops who know how to measure children’s feet and fit the correct size of shoe.

Some stores have had measuring boards available in the shoe section for some years, but using it was left to the customer. At the same time there was no guarantee that the size system on the board matched the size system of the shoes. Anyone who has bought sports shoes/trainers recently will know that they have three or four different size numbers on the tongue of the shoe. This is because the shoes are made in Asia for sale all over the world where the basic unit of measurement differs – including different centimetre units.

In an attempt to bring some order and science into the art of shoe fitting, the South African Podiatry Association (SAPA) has been working with various manufacturers and retailers to establish standards for footwear in this country. There is a committee of experts headed by a podiatrist who has done ground-breaking original research into the feet of South African women. This committee assesses lasts(the plastic shape around which a shoe is built) and footwear design, against a checklist based on this scientific research.

One retailer is Woolworths and if you buy your child’s shoes there – although you will have to fit them yourself – you will see certain styles have the SAPA approval logo on the green tag. Look out for other large retailers getting involved in 2008.