Plantar Fasciitis is a condition involving the large ligament-type structure in the sole of the foot that can cause heel pain and arch pain. The Plantar fascia becomes inflamed and irritated at its attachment at the base of the heel and it can sometimes have small tears. Sometimes Heel Spurs are present, but these are not the cause of heel pain. “Heel Spurs”is a misleading diagnosis that has been used for many years, and this is finally becoming more apparent to most medical professionals. The heel spurs don’t cause the pain, but the inflammation in the plantar fascia surrounding the spur, does.
Plantar Fasciitis is often described as the feeling of a stone bruise underneath the heel and usually causes pain when the foot hits the floor in a morning and after the patient has been on their feet for long periods.
Primarily, patients may feel a dull ache in the heel. This might be present in the afternoons, or after they have been on their feet for long periods. At this stage there may be some pulling in the Plantar Fascia, which can feel like tightness in the arch of the foot.
If patients engage in plantar fasciitis treatment at this stage they might not develop a full-blown foot condition. However, many people will ignore the early symptoms in the hope that the tightness and the dull ache in the heel will go away and later develop severe heel pain and chronic plantar fasciitis.
The common symptom that patients report is the feeling of a pebble in the shoe or a small stone bruise. People with mild Plantar Fasciitis often mention that they felt like they had stepped on a stone. In these early stages of the condition, Plantar Fasciitis does not always cause heel pain throughout the day. It can be sporadic and asymptomatic for a day or two before returning.
In the early stages of Plantar Fasciitis there can also be some heel pain in the morning when the foot hits the floor, but this is usually mild and is often little more than a feeling of tightness.
Plantar Fasciitis affects men and women both, but there is often a trend in the age of the patients that we see. People younger than 30 years of age rarely develop the condition, and the majority of patients with Plantar Fasciitis are in there 40’s, 50’s and 60’s. Men and women who haven’t exercised for a while and who decide to get fit, and often those who join boot camp, will commonly develop Plantar Fasciitis.
There is no single cause. There are a few typical contributing factors though, all of which lead to stress and strain of the plantar fascia.
Tight calf muscles, flat feet, an increase in body weight, soft shoes, poor foot function, a sudden increase in sporting activity or a return to sport, are just some of the common issues.
One of the most common ways to strain the fascia is to suddenly expose the foot to an increased workload. For example
…“I was training for an event and started running a lot more, and then my heel got sore”
…“I have just been on an overseas holiday where we walked a lot and I developed this pain in my heel”
Whatever the cause, Plantar Fasciitis is not a life long condition. It is always treatable. More about the treatment here: How we treat heel pain
The symptoms of Plantar Fasciitis are obviously more severe when the condition has fully developed. The strain on the Plantar Fascia has been ongoing and too much for the foot to cope with and hence the inflammation becomes severe.
Pain is now more consistent and there seems to be a pattern. Usually the patients with fully developed Plantar Fasciitis will report pain, not just tightness, every single morning. The heel pain can be so severe that the patients hobble for at least 5 minutes after getting out of bed. Patients are usually more comfortable after their morning shower and they can then walk without too much discomfort for large parts of the day.
Later in the day however, as the foot fatigues, heel pain returns. Plantar Fasciitis patients will report pain after driving home from work and getting out of the car, which makes them hobble. Or heel pain after they have been sat down having dinner or watching television. They stand up from their chair and hobble again. Treatment at this stage is crucial, before it turns severe or tears develop.
When the fully developed Plantar Fasciitis goes untreated, and there have been no changes to lifestyle and exercise regime then the heel pain becomes severe. The strain on the Plantar Fascia has been so great that acute inflammation develops to an extremely high level. An ultra sound report will often show thickening of the plantar fascia, in comparison to the good foot without heel pain.
Patients with severe Plantar Fasciitis will usually report extreme pain for most of the day. It’s not uncommon to hear the word “excruciating”. During periods of rest there are symptoms such as throbbing or shooting pains, and a stabbing sensation.
By this stage, patients with severe Plantar Fasciitis are at their whit’s end. The heel pain is constant and they get no relief. They feel desperate and have often been to see a variety of practitioners without success. There is also the possibility that patients with severe Plantar Fasciitis have developed tears in the fascia. We arrange an ultra sound scan, not X rays to confirm.