Plantar Fasciitis Exercises to Help Your Pain

How Plantar Fasciitis Exercises can Help

Plantar fasciitis is a leading cause of heel pain in Australians and one of the most common reasons for people to visit the sports podiatrist, as they enquire about plantar fasciitis exercises. Plantar fasciitis develops when the stress placed on the plantar fascia ligament causes micro-tearing and inflammation. Stress is usually due to overuse. As such, completing exercises and stretches regularly can assist with improving flexibility in the lower leg and foot, reducing the stress on the ligament.

When combined with other preventative and treatment measures- such as resting, icing, the use of recommended footwear and tailored orthotic inserts, shockwave therapy and more- exercises for plantar fasciitis can help in reducing heel pain and promoting healing of the damaged plantar fascia ligament.

How to Perform Exercises for plantar fasciitis

One of the hallmark signs of plantar fasciitis, is the intense heel pain that sufferers experience when they take their first steps out of bed in the morning. This pain is thought to be due to the plantar fascia ligament tightening during sleep. Taking the time to perform some simple exercises for a few minutes before walking around in the morning can help to alleviate that pain.

Stretches for Plantar Fasciitis to do Before you Get Out of Bed

Sit comfortably on the edge of your bed to complete the following exercises for plantar fasciitis:

  • Foot Flexion/Extension: Extend your leg out in front of you and flex your toes up and down ten times, repeating for each foot
  • Alphabet Stretch: Extend your leg out in front of you, and imagine your big toe is a pen. Trace out each letter of the alphabet, and repeat for the other foot

The stretches above are useful for promoting blood flow to the feet, loosening scar tissue and reducing the inflammation associated with plantar fasciitis.

Stretch for Plantar Fasciitis that can be Performed Any Time – Useful or Not?

It has been suggested, but there is little evidence to support the theory, that when you have a chance throughout the day, performing the following exercise can help relieve the heel pain caused by plantar fasciitis by assisting with strengthening the muscles of the foot and promoting blood flow to the area:

  • Towel Pick-Up: Find a small towel and put it on the floor in front of you. While seated, use your toes to scrunch the towel and pick it up, all the while keeping your heel on the floor. Perform 10 times for each foot.

Good or Bad Stretches for Plantar Fasciitis?

Tight calf muscles are often at the root of the problem in cases of plantar fasciitis. Poor flexibility in the calves places biomechanical strain on the Achilles tendon and the plantar fascia ligament as the person walks, leading to the development of conditions such as plantar fasciitis and Achilles tendonitis. The following exercises are suggestions for the types of exercises that you can perform that will help with increasing and maintaining flexibility in the calf muscles, improving the overall health of your lower legs and feet:

  • Calf-Plantar Fascia Stretch: ( CAUTION ) – this stretch may irritate the plantar fascia while assisting with calf range. Sit on the floor with your legs straight out in front of you and knees straight. Fold or roll a towel long ways and put it around your feet at the level of the balls of your feet. Hold each end of the towel in each hand and gently pull back towards yourself. Hold the stretch for 15-30 seconds and repeat four times
  • Floor Stretch: Stand next to a wall, placing your hands against it at shoulder height. Take a step back from the wall with both legs, and then another step back with the leg you’re wanting to stretch. Keeping the front knee slightly bent, slowly lean yourself in towards the wall until you feel the stretch in the back of your calf. Hold for 15-30 seconds and repeat four times and for each leg (CAUTION – foot must be supinated during stretch to avoid loading the plantar fascia)
  • Stair Stretch: ( NOT RECOMMENDED) – Loads the plantar fascia! Stand on the edge of a stair or step with both heels hanging off the edge. Balance by holding onto a rail or something else solid. Keep the leg you wish to stretch straight, and slowly and controlled, drop your heel downwards so that you feel a slight stretch through the Achilles tendon and calf. Some of your bodyweight should still be on the supporting leg. Hold for 15-30 seconds and repeat 4 times, and for each leg.

Plantar Fasciitis Exercises

Calf  Stretches for Plantar Fasciitis can help to Relieve your Pain

Over time and with consistent practice, the flexibility in your muscles, ligaments and tendons will increase, reducing the causes and pain from plantar fasciitis. Before you commence a stretching program, it is important to consult a qualified sports podiatrist, who will thoroughly assess your condition, make a correct diagnosis and advise you on which stretched are appropriate for your condition.

Please keep in mind that the above information is for educational purposes and it should not be taken as general medical advice. If you have plantar fasciitis, you should consult a qualified sports podiatrist prior to commencing an exercise program. Appointments can be made online at https://www.sydneyheelpain.com.au/book-online/ or by phoning (02) 93883322.

Karl Lockett – sports podiatrist

Plantar Fasciitis Causes and Risk Factors Explained

An Introduction to Plantar Fasciitis Causes and Risk Factors

Plantar fasciitis causes sufferers debilitating heel pain and frustration. It is one of the most common complaints of patients that visit the sports podiatrist. Plantar fasciitis occurs when the plantar fascia ligament, which runs along the base of the foot, becomes inflamed or irritated. This strong and fibrous ligament connects the base of the heel bone to the base of the toes and functions to support the arch of the foot and distributes forces as a person walks or runs. With repeated strain, micro-tearing occurs, leading to inflammation and heel pain and/or arch pain in the patient.

Plantar Fasciitis Causes Patients Heel Pain and Arch Pain

Plantar fasciitis is usually diagnosed based on symptoms and history. Patients often report that their plantar fasciitis causes them the worst pain first thing in the morning as they rise from bed. The pain is commonly described as burning, stabbing, or sharp, like a nail in the base of the heel. Burning or tightness may also be felt through the arch of the foot. Quite commonly, patients report that their pain subsides after some time of moving around. It may feel very painful again if the patient starts to walk after a period of sitting or standing in one spot for some time. Patients do not usually have pain during exercise, and this sign is often something that differentiates plantar fasciitis from other conditions that may be causing heel or arch pain.

Plantar Fasciitis Causes and Risk Factors Explained

Plantar Fasciitis Causes Explained

There are a number of circumstances, or risk factors, which can lead to a situation where the condition develops and plantar fasciitis causes heel or arch pain for the patient. Understanding that the development of the condition is multi-factorial is important; many health professionals fail to address all possible plantar fasciitis causes in their patient, and therefore in many cases, their treatment fails. This is not always the case though! The sports podiatrists at the Sydney Heel Pain Clinic are incredibly experienced in addressing the causes and treating plantar fasciitis in people of all ages and levels of participation in physical activity. We have detailed for your information, just some of the many plantar fasciitis causes that we consider when preparing a treatment plan for each patient.

Plantar Fasciitis Causes: Suboptimal Foot Biomechanics

One of the common plantar fasciitis causes and a large contributing factor are the biomechanics of a persons foot, and their gait (walking/running style). A biomechanical assessment and gait analysis is almost always conducted as part of the diagnostic process for plantar fasciitis, because it allows the sports podiatrist to accurately identify imbalances, malalignments and gait abnormalities in the patient. Foot arch height and the range of motion of the ankle are also assessed. People with flat feet (pes planus) or high arches (pes cavus) are at greatest risk of developing plantar fasciitis. In people with flat feet, the arch collapses as the person weight-bears on the foot, causing the plantar fascia to stretch and pull away from the heel bone, causing inflammation. In people with high arches, their plantar fascia ligament is often very tight, and in those patients, plantar fasciitis causes a lot of tension and pain.

Plantar Fasciitis Causes: Tight Calf Muscles

Plantar fasciitis causes heel pain at the bottom the foot, often because the calf muscles are tight. This lack of flexibility leads to a reduced range of motion at the ankle, which in turn puts extra strain on the plantar fascia ligament.

Plantar Fasciitis Causes: Overweight and Obesity

Carrying extra bodyweight if you are overweight or obese is a risk factor for developing plantar fasciitis. Your lower legs and feet bear the weight of your body, and when undue pressure is placed on the structures of the lower limb, there is excessive strain of the plantar fascia ligament as it attempts to support the foot arch correctly and distribute the forces of your movement through your foot. Particularly in patients with sudden weight gain, plantar fasciitis causes acute and severe pain in the heels and arches.

Plantar Fasciitis Causes: Physical Activity that is Demanding on the Feet

In terms of athletes, plantar fasciitis causes pain for runners, most commonly. Sudden increases in distance, frequency, or intensity of training put the runner at greater risk of developing the condition. The plantar fascia is made of collagen, which is a tissue that is not very stretchy, so if it is not allowed ample time to adapt to and recover between bouts of training, injury and inflammation may arise. Similarly, occupations that require a person to be on their feet for extended periods (such as factory workers or restaurant staff) are at greater risk of plantar fasciitis, due to the constant pressure on the plantar fascia. Factors such as the type of footwear a person wears and the surface on which they exercise or work on also impact the development of the condition.

Plantar Fasciitis Causes: Poor Footwear Choices

Plantar fasciitis causes problems for people who spend a lot of time wearing unsuitable or less than ideal footwear for exercising or daily activities. Some of the common problematic types of footwear include thongs or flip flops, flat or unsupportive shoes such as ballet flats, or minimalist running shoes for long distance runners. Generally speaking, all of the aforementioned shoes fail to provide adequate support for the foot, placing extra pressure on the plantar fascia and causing strain.

Plantar fasciitis causes heel pain and arch pain in many people; athletes and non-physically active people alike. The information provided in the article above, regarding plantar fasciitis,  should not be taken as general advice and is intended for educational purposes only. If you are experiencing heel pain or arch pain, or you suspect that you might have plantar fasciitis, you should consult with a qualified sports podiatrist to discuss your condition. You can make an appointment online at www.sydneyheelpain.com.au or by calling 93883322.

Karl Lockettsports podiatrist.

 

Obtaining an Accurate Plantar Fasciitis Diagnosis

An Introduction to Plantar Fasciitis Diagnosis

Plantar fasciitis is a leading cause of heel pain in patients of all ages. One of the main reasons people visit the sports podiatrist is for a correct diagnosis and accurate evaluation of their plantar fasciitis. In many cases, diagnosing the patient’s plantar fasciitis is straightforward, however in some cases there are other conditions that need to be ruled out. This might happen in situations where the patient has multiple other symptoms or foot-associated injuries which can confound judgement. The efficacy of the treatment approach entirely depends on an accurate diagnosis and assessment of the patient’s plantar fasciitis. For this reason, it is important to consult an experienced sports podiatrist for an expert evaluation of plantar fasciitis.

Anatomy and Pathophysiology of Plantar Fasciitis Diagnosis

A thorough understanding of the anatomy and biomechanics of the lower leg and foot are important when confirming a plantar fasciitis diagnosis and assessing the severity of the condition. The plantar fascia is a very strong ligament runs along the arch of the foot and connects the bottom of the heel bone to the bone at the base of the toes. The function of the plantar fascia is to support the arch of the foot and distribute forces when the person walks.

Plantar fasciitis occurs when the plantar fascia ligament becomes injured or inflamed. This generally occurs with repetitive strain or overuse, which can be the result of several factors. Inflammation is the body’s natural response to injury and strain in an attempt to repair the damaged tissues. When plantar fasciitis develops, the plantar fascia becomes thickened. If the condition is left untreated, over time the issue becomes chronic and degenerative, which can lead to the breakdown of the connective tissue in the ligament and the formation of heel spurs.

Accurate Plantar Fasciitis Diagnosis

Plantar Fasciitis Diagnosis by the Sports Podiatrist

The sports podiatrist will conduct a thorough examination in order to confirm the plantar fasciitis diagnosis. Their assessment will allow them to exclude any differential diagnoses, so that the patient is sure to receive the most correct and effective treatment for their condition.

When considering a plantar fasciitis diagnosis, the podiatrist will firstly be looking for plantar heel pain that is possibly described as sharp, stabbing or burning. The pain is typically at its worst first thing in the morning when the person takes their first steps out of bed, then subsides after a few minutes of walking, as the feet begin to warm up. The pain is also usually bad after a period of rest or prolonged sitting or standing.

During the consultation and diagnostic process, the sports podiatrist will consider whether the patient has any of risk factors that are associated with plantar fasciitis. Some of these risk factors include:

  • The patient’s gender, with females being at greater risk than males
  • The patient’s age, with risk of developing plantar fasciitis increasing with age
  • The patient’s BMI, with overweight and obese people being at greater risk
  • The patient’s occupation; people in jobs that involve standing for long periods of time are at greater risk of developing plantar fasciitis
  • Any physical activity that the patient participates in; runners are at increased risk.

Biomechanical Assessment and Gait Analysis in Plantar Fasciitis Diagnosis

As part of their assessment for plantar fasciitis, the sports podiatrist will most likely conduct an in-house biomechanical assessment and gait analysis. This is a particularly useful diagnostic tool, as it allows the sports podiatrist to accurately identify any imbalances, abnormalities or malalignments that may be putting pressure or strain on the plantar fascia as the person walks or runs, contributing to the development of plantar fasciitis and other conditions. In order to conduct the assessment, removable markers are placed on landmarks on the patient’s lower leg, ankle and foot. The patient walks or runs on the treadmill, as instructed, whilst a camera records footage of their leg and foot movement. The footage is then replayed in slow motion and analyzed by the sports podiatrist. Range of motion of the ankle and the height of the foot arch are also measured, as tight calf muscles, high arches and flat feet are also risk factors for the development of plantar fasciitis.

The Role of Medical Imaging in Plantar Fasciitis Diagnosis

Medical imaging is not normally necessary when diagnosing plantar fasciitis, except in certain cases where perhaps alternative conditions need to be excluded, or in cases where the patient has had persistent pain for many months and conservative treatments have not been successful. In such cases, MRI, ultrasound or xray may be indicated.

Treatment Following Plantar Fasciitis Diagnosis

Once your sports podiatrist has made a plantar fasciitis diagnosis and assessed the severity of the condition, an individualized treatment plan can be implemented. Treatment schedules and methods vary from patient to patient, and will depend entirely on individual patient factors, including lifestyle and participation in physical activity. Treatment plans are generally multi-factorial, combining a few methods of treatment for the most effective recovery. Just some of these treatments may include: resting to reduce inflammation, custom-made orthotic inserts to correctly support the arches of the feet, modifying footwear to be appropriate for the patient’s foot biomechanics, stretching the calf muscles to relieve pressure on the plantar fascia, and extracorporeal shockwave therapy, which promotes healing and tissue regeneration. Your sports podiatrist will advise you which treatments are appropriate for your condition.

Please note that the information provided in the article above regarding the diagnosis and evaluation of plantar fasciitis is intended for educational purposes only. It should not be taken as general medical advice. If you have heel pain or suspect that you might have plantar fasciitis, you should make an appointment with a suitably qualified sports podiatrist, who can provide a sound diagnosis and assessment. Appointments can be made online at https://www.sydneyheelpain.com.au/book-online/ or by phoning (02) 93883322.

Podiatrist – Rami GHORRA

Plantar Fasciitis vs Heel Spurs

Plantar fasciitis and heel spurs are two completely different conditions that are closely related to one another, and are often related to chronic heel pain. Being informed of what the differences between the two conditions are and how they are related to each other, is useful in understanding why your sports podiatrist may prescribe a particular treatment plan, and what you can do to help relieve pain and discomfort.

Plantar Fasciitis vs Heel Spurs

What is plantar fasciitis?

Plantar fasciitis is a painful condition that occurs when the strong band of tissue that supports your foot arch (the plantar fascia ligament) becomes irritated and inflamed, usually around the base of the heel bone but also through the arch or sole of the foot at times.

What is a heel spur? (plantar)

A heel spur is a bony protrusion on the heel bone. Heel spurs often develop in the area of the heel bone where the plantar fascia attaches. Heel spurs may vary in shape and size.

Causes of plantar fasciitis vs heel spurs (plantar)

Plantar fasciitis is caused when repeated or excessive pressure on the plantar fascia ligament causes strain and leads to micro-tearing of the tissue. Because of this tearing, the body’s natural response is inflammation. The inflammation is what causes the pain and stiffness patients with plantar fasciitis experience. People who are female, middle aged, overweight, pregnant, or who wear unsupportive or worn-out footwear are at higher risk of developing plantar fasciitis. Long distance runners and people who work in jobs that require them to stand for long periods of time are also at higher risk. Structural issues with the feet, such as having high arches or flat feet, or a suboptimal walking pattern also put a person at risk of developing plantar fasciitis. Tight calf muscles almost always present when a patient is diagnosed with plantar fasciitis.

Heel spurs are caused by calcium depositing on the heel bone, in response to chronic strain. They are often a secondary result of chronic plantar fasciitis, which has lasted many months. The body deposits calcium at the site of the plantar fascia attachment in an attempt to support the damaged ligament. Heel spurs do not develop overnight or in response to acute trauma.

Symptoms of plantar fasciitis vs heel spurs

Patients with plantar fasciitis classically experience a sharp, stabbing or burning sensation in the area of the heel close to the arch, but also sometimes right across the arch of the foot itself, which is worse first thing in the morning. The pain may subside as the day goes on. Patients often don’t experience pain during exercise, however as soon as they stop, the pain comes back immediately and is usually intense.

Patients with heel spurs tend to describe a stabbing sensation in the heel. Whilst heel spurs were once thought to be the cause of heel pain, it is now widely accepted amongst medical professionals that the spurs themselves are not the problem. Rather, the pain is caused by the spur physically pressing into the surrounding tissues, causing them to become inflamed and painful. Pain related to heel spurs may be worse in the morning and intermittent throughout the day. Often, there is no spur present in patient’s with plantar fasciitis, so it can be assumed that they don’t cause pain at all.

 According to one particular study, approximately half of patients with plantar fasciitis also have heel spurs1. Quite often, heel spurs are discovered incidentally on xrays that are taken for other purposes. Only around 5% of patients with heel spurs report having pain in the heel1.

Treatment for plantar fasciitis vs heel spurs

If left untreated, plantar fasciitis can lead to heel spurs. Both conditions are often treated using a similar approach. Once your sports podiatrist has confirmed a diagnosis of plantar fasciitis with or without heel spurs, a treatment program can be tailored to your individual condition.

There are a number of different treatments available for plantar fasciitis and heel spurs. Some of the treatments that may be recommended by your sports podiatrist could include:

  • Shockwave therapy– promotes blood flow, tissue regeneration and provides pain relief from plantar fasciitis
  • Rest- taking a break from activities that cause you pain or aggravate your condition, or perhaps modifying those activities
  • Icing- applying cold packs to your sore feet can help to reduce inflammation
  • Stretching- your sports podiatrist will recommend and demonstrate the types of stretches that are appropriate for your condition
  • Orthotic inserts- custom-made orthoses can help to support and control the arch of the foot to unload the plantar fascia and allow it to heal
  • Footwear- your sports podiatrist may suggest that you use a different type of footwear to what you currently have, in order to support your foot correctly.

Your sports podiatrist will not be looking to remove a plantar heel spur surgically or otherwise as it is not the cause of your heel pain.

Please note that the information provided in this article, regarding the differences between plantar fasciitis and plantar heel spurs is intended for educational purposes only. It is not intended to diagnose any condition, nor should it be taken as general medical advice. If you are suffering with any type of heel pain or suspect that you may have a heel spur or plantar fasciitis, you should consult with a suitably qualified sports podiatrist. You can make an appointment with one of our podiatrists online at https://www.sydneyheelpain.com.au/book-online/ or by phoning (02) 93883322.

 References

1Ferreira, R. C., (2014), Talalgia: plantar fasciitis, Revista Brasiliera de Orthopedia, 49 (3), 213-217.

 

Podiatrist

Karl Lockett

 

 

Plantar Fasciitis: An Overview

In Introduction to plantar fasciitis

Plantar fasciitis is the most common cause of heel pain in patients. It is a painful condition that can affect people of all ages and activity levels. Thankfully, your sports podiatrist is an expert in diagnosing plantar fasciitis, and there are a number of effective treatments available.

What is plantar fasciitis?

Plantar fasciitis is a painful condition of the heel of the foot. When plantar fasciitis occurs, the plantar fascia ligament becomes irritated and inflamed. It may also become significantly thickened. The plantar fascia ligament is a strong, dense structure that is located at the base of the foot. It connects the heel bone to the toe bones at the ball of the foot. The plantar fascia’s function is to help with weight bearing and force distribution through the foot when a person walks. It also assists the arch of the foot to stay supported in an upright position.

Plantar Fasciitis: An Overview

What are the symptoms of plantar fasciitis?

Plantar fasciitis causes some characteristic signs and symptoms in its patients. Some of these include:

  • Sharp, stabbing or burning pain in the base of the heel
  • Pain that is usually at its worst when getting up out of bed in the morning, but typically subsides after a few minutes of walking
  • Pain after prolonged periods of sitting or standing
  • Pain immediately following a period of intense exercise.

What risk factors increase the chances of developing plantar fasciitis?

Plantar fasciitis can occur in people of all ages and activity levels, however there are risk factors that can increase a person’s chances of developing the condition. Some of these risk factors include:

  • Age: people aged between 40 and 70 are at greatest risk
  • Sex: females are at greater risk than men
  • Pregnancy: females often experience bouts of plantar fasciitis during pregnancy, especially with sudden weight gain and ligament laxity
  • Overweight and obesity increase a person’s risk of developing plantar fasciitis
  • People who run often or over long distances are at increased risk
  • Occupation: people whose jobs require them to be on their feet for long periods are at increased risk
  • structural problems of the lower leg and foot: people who have high arches, flat feet, or tight Achilles tendon and calf muscles are at increased risk
  • Footwear: wearing very flat or unsupportive footwear such as ballet flats or flip flops increases a person’s risk of developing plantar fasciitis.

How is plantar fasciitis diagnosed?

Your sports podiatrist is an expert in diagnosing plantar fasciitis. The diagnosis of plantar fasciitis is often made based upon the patient’s presenting symptoms and clinical signs. The sports podiatrist considers the patient’s exercise and medical history and lifestyle. They conduct a thorough physical examination, including palpating the foot to see if the pain can be pin-pointed or reproduced. A biomechanical analysis is carried out in most cases, in order to assess the patient’s gait (style of walking or running). This allows for the sports podiatrist to determine if there are any structural abnormalities, malalignments or imbalances in the lower limb and foot that could be contributing to the patient’s heel pain and plantar fasciitis. In some situations, diagnostic imaging, such as an ultrasound or xray may be required in order to rule out other differential diagnoses such as bursitis.

What are the treatment options for plantar fasciitis?

Your sports podiatrist may recommend a number of different treatments for plantar fasciitis. The methods that they choose to incorporate in to your treatment plan will be largely based upon the results of the biomechanical analysis, and any lifestyle factors that need to be considered, such as whether or not you are a competitive athlete, or if you have any medical conditions. Some of the common treatments for plantar fasciitis include:

  • Shockwave therapy: which stimulates blood flow, tissue regeneration and recovery, and provides fast pain relief from plantar fasciitis
  • Stretching: usually in the calf muscles, which reduces strain on the plantar fascia, providing pain relief and long-term prevention of recurrence
  • Custom-made orthotics: which touch the arch and provide control and support, unloading the plantar fascia and allowing it to heal naturally
  • Strapping techniques: to help support the arch of the foot and unload the plantar fascia
  • Footwear: your sports podiatrist may recommend a particular type of shoe that will be appropriate for supporting and controlling the arch of your foot correctly.

Your sports podiatrist may also recommend that you apply an ice pack to the area on a dailt basis or after exercise, to reduce inflammation. Anti-inflammatory drugs are not generally recommended, or only as a last resort in very painful cases, as they tend to mask the problem rather than helping to heal the underlying condition.

Please be aware that the information stipulated in the article above regarding plantar fasciitis is intended for educational purposes only and should not be taken as general medical advice. If you are experiencing heel pain or suspect that you may have plantar fasciitis, you should consult with an appropriately qualified sports podiatrist. Appointments can be made online at https://www.sydneyheelpain.com.au/book-online/ or by phoning (02) 93883322.

Podiatrist

Rami Ghorra

Shockwave Therapy for Plantar Fasciitis Treatment

While there are a number of treatments available for plantar fasciitis, many do not provide satisfactory results for the patient and some have undesirable side effects. Shockwave therapy has been shown to be a safe and effective treatment for plantar fasciitis.

What is plantar fasciitis?

Plantar fasciitis is a common cause of plantar heel pain in patients. It is a condition where the plantar fascia ligament becomes irritated, inflamed, thickened and very painful. The plantar fascia is a strong and fibrous structure that runs along the base of the foot, connecting the heel bone to the toes at the ball of the foot. Its purpose is to assist with distributing forces and weight as a person walks, and to support the arch of the foot.

Plantar fasciitis is usually the result of overuse or repetitive strain on the plantar fascia ligament. It occurs most commonly in females, middle aged people, people whose occupations require them to be standing for extended periods of time, those with either flat feet or high arches, and people who engage in a lot of running and walking.

Plantar fasciitis causes a characteristic sharp, hot, stabbing pain at the plantar aspect of the heel (the part where the ligament attaches to the heel bone). Most commonly, patients report the pain is worse in the mornings as they get out of bed, or after a period of rest.

What is shockwave therapy?

Shockwave therapy (also known as extracorporeal shockwave therapy, ESWT) is a treatment that is used across many medical fields. Using a hand-held probe, the sports podiatrist directs high energy sound waves into the patient’s affected area that is requiring treatment. The energy promotes tissue healing and regeneration, stimulates blood flow to the area, and provides the patient with almost instant pain relief.

Shockwave Therapy for Plantar Fasciitis Treatment

What are the benefits of shockwave therapy for plantar fasciitis treatment?

Clinical studies have demonstrated shockwave therapy to be an effective treatment for plantar fasciitis. It is a treatment that is championed by many medical professionals including sports podiatrists, because of its efficacy and safety with lack of side effects. Numerous studies have documented the reduction in the thickness of the plantar fascia with chronic plantar fasciitis1,2, which is indicative of healing. A number of studies have also determined that shockwave therapy is an effective treatment in reducing pain for plantar fasciitis sufferers2,3,4. It is a non-invasive treatment and one which can be conveniently performed in-clinic during your consultation with your sports podiatrist.

Is shockwave therapy for plantar fasciitis painful?

Whilst some patients experience slight pressure or discomfort, the treatment is not generally painful. Given that shockwave therapy only usually lasts for around five minutes a session, most patients are able to tolerate it quite well. You should communicate any discomfort to your sport podiatrist as they also have the ability to reduce the intensity of the treatment, and increase it gradually over the course of your shockwave therapy sessions as you become more tolerant.

How many sessions of shockwave therapy for plantar fasciitis are required?

Since the effect of shockwave therapy is cumulative, you will need more than one. Most patients have between three to six sessions, however sometimes more are required depending on the severity and complexity of a condition. Most patients do however experience some pain relief after just one session.  Your sports podiatrist will advise you as to how many sessions you will require and what the frequency of these will be. Sessions are usually around a week apart for treatment of plantar fasciitis.

Readers are advised that the information regarding shockwave therapy for plantar fasciitis treatment that is detailed above is for educational purposes only and should not be taken as general medical advice. If you have been diagnosed with plantar fasciitis or wish to discuss the potential benefits of shockwave therapy for your condition, you should make an appointment with a qualified sports podiatrist. Appointments can be made online at https://www.sydneyheelpain.com.au/book-online/ or by phoning (02) 93883322.

Further reading and references

1Vahdatpour, B., Sajadieh, S., Bateni, V., Karami, M., Sajjadieh, H., (2012), Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments, Journal of Research in Medical Sciences, 17(9), 834-838.

2Hammer, D. S., Adam, F., Kreutz, A., Rupp, S., Kohn, D., Seil, R., (2005), Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy, Archives of Orthopaedic and Trauma Surgery, 125(1), 6-9.

3Lou, J., Wang, S., Liu, S., Xing, G., (2017), Effectiveness of extracorporeal shockwave therapy without local anaesthesia in patients with recalcitrant plantar fasciitis: a meta-analysis of randomized controlled trials, American Journal of Physical Medicine and Rehabilitation, 96(8), 529-534.

4Agil, A., Siddiqui, M. R., Solan, M., Redfern, D. J., Gulati, V., Cobb, J. P., (2013), Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs, Clinical Orthopedics and Related Research, 471(11), 3645-3652.

 

Plantar Fasciitis Shoes and Footwear Choices

What are plantar fasciitis shoes?

There are a number of shoes on the market that claim to be plantar fasciitis shoes. In simple terms, these are types of orthopedic shoes that claim to be an effective method of naturally realigning the foot and alleviating heel pain associated with plantar fasciitis. At present, there is no credible scientific evidence relating to the effectiveness of plantar fasciitis shoes.  

What is plantar fasciitis?

Plantar fasciitis is an inflammatory condition that affects the plantar fascia ligament. This ligament runs along the bottom of the foot, connecting the base of the heel bone to the base of the toes. When this ligament develops micro-tears due to overuse or injury, plantar fasciitis develops, causing heel pain. A classic hallmark of plantar fasciitis is the sharp and stabbing pain that sufferers experience in the centre of the base of their heel, first thing in the morning as they get up out of bed. But can plantar fasciitis shoes help?

What causes plantar fasciitis?

Plantar fasciitis can be caused by a many number of contributing factors. Most commonly, it is caused by overuse, or repetitive strain to the plantar fascia ligament. This type of strain can occur with excessive or sudden increase in running or walking or repetitive jumping. There are certain risk factors that can increase a person’s chances of developing plantar fasciitis, and these include:

  • Age: plantar fasciitis risk increases with age
  • Foot biomechanics: flat feet (pes planus), high arches (pes cavus) or suboptimal gait (walking pattern) can put extra pressure on the plantar fascia when walking or standing
  • Tight calf muscles: having poor flexibility in your calf muscles places extra pressure on the plantar fascia
  • Overweight and obesity: extra body weight puts extra pressure on the structures of the feet and ankles, including the plantar fascia, increasing the risk of plantar fasciitis
  • Footwear: flat or unsupportive footwear can contribute to the development of plantar fasciitis
  • Occupation: jobs that require a person to be on their feet for extended periods on hard surfaces (such as factory workers) increase a person’s risk of plantar fasciitis due to injury of the plantar fascia ligament.

Are plantar fasciitis shoes necessary?

Given that there is currently no peer-reviewed scientific evidence to support the efficacy of any specific type of  plantar fasciitis shoes, the short answer is no, they are not necessary. Some types of plantar fasciitis shoes claim to provide support to the feet, however there are other forms of support that can be very beneficial in providing control and stability for the foot. Your sports podiatrist can advise you as to which types of support are most appropriate for you. These may include strapping techniques, prescription/custom-made orthotic inserts, or in some cases, immobilization boots.

Plantar Fasciitis Shoes and Footwear Choices

What types of plantar fasciitis shoes are there?

Whilst there is no one type of most appropriate plantar fasciitis shoes, there are some types of shoe that you should avoid if you already have plantar fasciitis, or in order to prevent the development of the condition. You should avoid wearing shoes that provide little or no support to the feet for prolonged periods of time. Some examples of such shoes include ballet flats and regular flat-soled flip-flops or thongs. These types of shoes don’t provide any arch or heal support for your foot, and in the case of flip-flops, your toes are constantly trying to grip to keep them on. In the long term this can lead to several issues in the feet, including strain of the plantar fascia.

 

Your sports podiatrist can assist you in selecting footwear that offers high levels of support to the heels, soles and arches of your feet. Functional running shoes are often suggested as a footwear option for people who have plantar fasciitis, since they provide arch support, however these can be quite costly, so it is always best to consult with your sports podiatrist as to which brands or makes of shoe might be appropriate for your foot. There are a number of options in footwear brands nowadays, from sandals to working shoes, which are better choices than flat-soled, unsupportive shoes.

 

Please note that the information regarding plantar fasciitis shoes and footwear choices mentioned above, is for educational purposes only and should not be taken as general medical advice. If you are suffering with plantar fasciitis or wish to discuss plantar fasciitis shoes or footwear choices, you should make an appointment with a sports podiatrist. Appointments can be made online at https://www.sydneyheelpain.com.au/book-online/ or by phoning (02) 93883322.

 Podiatrist – Karl Lockett

Plantar Fasciitis Socks: Do they work?

Plantar fasciitis socks have recently gained popularity as a cost-effective home remedy for plantar fasciitis. A quick internet search will return dozens of websites flogging their wares, claiming to heal your plantar fasciitis. From footless, to knee length, black, nude or purple, with or without a gel heel, and even those that include pouches for ice packs or splints or straps for support, the options for plantar fasciitis socks seem endless and incredibly confusing. Prices also seem to vary considerably, from around $10 all the way up to $50. To compound the issue further, it can be incredibly easy to get lost in all the medical jargon on the product descriptions.

But at the end of the day (no pun intended!), Do plantar fasciitis socks even work?

The short answer to this commonly asked question about the efficacy of plantar fasciitis socks is we don’t really know. Whilst there seems to be a fair amount of anecdotal evidence out there on the World Wide Web from people who suggest that plantar fasciitis socks healed their condition, there is no published, peer-reviewed clinical evidence to suggest that this is scientifically true.

As a sports podiatrist and medical professional, I need to consider medical facts. It is imperative that the treatments that we use in practice are not only safe, but effective and proven. Plantar fasciitis socks do not yet fall into this category of treatment. Interestingly, whilst writing this post, we came across one website claiming to link their product back to a clinical trial, however when we followed their link to read the evidence for ourselves, no such article existed.

So what about all the people out there who say that plantar fasciitis socks treated their condition? Well, that is a big call to make, and a complicated one at that. The reason is simple: in the field of medical science, or in any scientific field for that matter, for a claim to efficacy to be made, there must have been at least one, but usually many reproducible trials. And when a trial is conducted, there are ‘rules’. These rules refer to the scientific principles that must be followed so that studies remain unbiased and valid. In very short and simple terms, there are variables that must be correctly controlled, so that results can be accurately statistically analyzed to produce meaningful conclusions, which can be reproduced again and again.

For example, if a study was to be carried out on the efficacy of plantar fasciitis socks in treating plantar fasciitis in patients, the researchers would need to consider and control variables such as the type of footwear the patients wear, the number of steps the patients take, notes on any physical activity the patients engage in, the severity or degree of injury of the patients’ plantar fasciitis to begin with, and bodyweight, gender, and related medical conditions, just to name a few. Researchers would need to consider how they would avoid biased reporting or ‘placebo effect’ in patients, and how they would tangibly measure the healing effect of the plantar fasciitis socks.

So then how are plantar fasciitis socks giving people relief? At a glance, they are offering some pain relief due to their compression. Now, your sports podiatrist would tell you that compression is widely accepted as an effective way to reduce swelling and inflammation. But it can be achieved with correct strapping technique, no fancy overpriced plantar fasciitis socks necessary. It is also highly unlikely that compression alone is enough to allow an injured plantar fascia to heal. As mentioned previously, any other treatments or remedies that the patient is concurrently using, would also be affecting the healing and pain relief process. Whilst using their socks, perhaps they have been resting their feet more, perhaps they have been using some prescribed exercises, perhaps they are using cold therapy or other treatments…without this information, we cannot draw conclusions.

Plantar Fasciitis SocksOkay then, what treatments other than plantar fasciitis socks exist, that are proven to work?

 If you are suffering with plantar fasciitis, rather than purchasing plantar fasciitis socks, speak to your sports podiatrist about clinically proven treatments. Some examples of such treatments include custom-made orthotics, which support the patient’s arch appropriately, unloading the plantar fascia and allowing it to heal, and shockwave therapy, which is proven to stimulate blood flow, tissue regeneration and provide almost instant pain relief.

The sports podiatrists at our clinic do not currently stock plantar fasciitis socks, nor do we plan to do so in any foreseeable future. This is simply due to the lack of credible scientific evidence regarding the product. This is not to say that plantar fasciitis socks do not have a place in providing some relief to people with foot conditions; they may provide some benefits to people who have fatigued feet or other conditions, but as it currently stands, there is a lack of evidence of their efficacy for treating plantar fasciitis.

Please be aware that the information provided in this post should not be taken as general medical advice. It is intended to be informational only. If you are suffering with plantar fasciitis, you should consult a sports podiatrist for a proper diagnosis and a tailored treatment plan. Please be mindful of the evidence before purchasing plantar fasciitis socks.

 

Podiatrist – Karl Lockett

Sydney Heel Pain Clinic – 93883322

https://www.sydneyheelpain.com.au/book-online/

 

Pain in the Back of the Heel

What causes pain in the back of the heel?

Pain in the back of the heel, or posterior heel pain, as it is medically referred to, is most commonly caused by either calcaneal apophysitis (Sever’s disease), Achilles tendonitis, Achilles tendon bursitis (retrocalcaneal or retroachilles bursitis), or a heel spur at the back of the heel (Haglund’s deformity, ‘pump bump’, retrocalcaneal exostosis).

Pain in the back of the heel due to Calcaneal apophysitis (Sever’s disease)

Sever’s disease is a common cause of heel pain in the back of the heel in children and adolescents aged between 8 and 14 years old2. This condition occurs when excessive tension and stress are placed on the calcaneal apophysis (the growth plate area of the heel bone), causing inflammation and irritation in this area. Young patients with this condition may complain of pain in one or both heels. The pain in the back of the heel is often described as a constant bruise, which feels more painful with exercise. Whilst any child may become affected, Sever’s disease is most common in those who participate in sports where lots of jumping is required, such as basketball, volleyball or gymnastics.

Pain in the Back of the Heel

Figure 1. Diagram of the anatomy of the foot, showing the location of the growth plate (apophysis) at the heel bone. The red area shows the typical area where a patient with Sever’s disease may feel pain and tenderness.

Pain in the back of the heel due to Achilles tendonitis

In adults, pain in the back of the heel is most commonly associated with Achilles tendonitis1. Achilles tendonitis occurs when the Achilles tendon at the back of the lower leg, becomes irritated and inflamed. This happens most commonly due to intense or repetitive strain on the tendon. Patients describe the pain in the back of the heel as uncomfortable and limiting. Patients often have reduce range of motion in their ankle and tightness in their calf because of the pain. Sometimes there may be redness, swelling or heat in the back of the heel and stiffness.

back of the heel due to Achilles tendonitis

Figure 2. Showing swelling of the patient’s leg due to Achilles tenonditis3.

 Pain in the back of the heel due to a Haglund’s deformity (Pump Bump, retrocalcaneal exostosis)

Haglund’s deformity is a very common clinical condition that causes pain in the back of the heel of the patient4. It is also known as a ‘pump bump’ or retrocalcaneal exostosis, in medical terms. It occurs when an abnormal bony spur forms at the back of the heel bone, at the insertion point of the Achilles tendon. The soft tissues in the area then become irritated and inflamed when the bone spur rubs against tight fitting or rigid shoes. The condition is most common in middle-aged females, but males may also be affected. A painful enlargement is often visible at the back of the heel and the pain is usually worse after a period of rest.

swelling on the back of both heels

Figure 3. Clearly shows the prominent swelling on the back of both heels of the patient, caused by Haglund’s deformity4.

Pain in the back of the heel due to Achilles tendon bursitis (retrocalcaneal or retro Achilles bursitis)

When the bursae in the posterior area of the calcaneus become inflamed or irritated, this is known as bursitis, and causes pain in the back of the heel. The bursae are flat, fluid-filled sacs that provide cushioning and reduce friction in areas where muscles, tendons and ligaments run over bones. Retrocalcaneal bursitis is the inflammation of the bursa between the Achilles tendon and the heel bone. Retro Achilles bursitis is the inflammation of the bursa between the Achilles tendon and the skin. Retrocalcaneal bursitis usually occurs from constant irritation and pressure on the bursa, such as lots of uphill running, or in association with Haglund’s deformity. Retro Achilles bursitis is almost exclusively caused by footwear that digs into the back of the heel. Sometimes both types of bursitis occur at the same time. Symptoms of bursitis include swelling, redness, and achy pain that becomes worse when the foot is flexed upwards or pointed down.

Achilles Tendonitis

Figure 4. Diagram of the anatomy of the foot, showing the locations of the bursae associated with the Achilles tendon that may become inflamed and cause pain in the back of the heel.

Diagnosing the cause of pain in the back of the heel

Your sports podiatrist is an expert in diagnosing the conditions that cause pain in the back of the heel. Your consultation will begin with a discussion about your pain and symptoms. Your podiatrist is likely to ask you questions about things such as:

  • Your age and regular occupation
  • Whether your pain feels worse at particular times of the day or with particular activities
  • Whether you’ve had any recent injury to the area
  • Whether you participate in any sports or physical activities
  • What type of shoes you normally wear, how well they fit and how often you replace them with a new pair
  • Medical history related to your legs and feet (such as injuries, arthritis, diabetes)
  • Whether you are currently taking any medications.

During your consultation, your sports podiatrist will also conduct a thorough physical examination of your feet, which may include:

  • A biomechanical assessment of your feet, to evaluate your gait (walking pattern) and detect imbalances, malalignment or other abnormalities related to the function of your feet and ankles
  • A physical examination of your feet and ankles, including comparing the painful and non-painful foot for any differences. They will also check for pain and tenderness, any palpable abnormalities such as swelling, muscle weaknesses and range of motion
  • A neurological examination, to assess the nerves and muscles by checking for strength, reflexes and sensation.

In some cases, your sports podiatrist may ask you to have an xray or other medical imaging, which will help in diagnosing the cause of your pain in the back of the heel.

Treatment for pain in the back of the heel

Treatment for your heel pain will be based on the diagnosis. In many cases, treatment for pain in the back of the heel is conservative. Your sports podiatrist may suggest treatments such as rest, application of ice packs, shoe inserts, shock wave therapy, heel lifts, stretches or orthoses. In cases where pain is severe or conservative treatments are not working, NSAIDs (non-steroidal anti-inflammatories) such as ibuprofen may be recommended for short term use.

 Please be aware that the information provided above, regarding pain in the back of the heel should not be taken as general advice and is for informational purposes only. If you are experiencing heel pain you should endeavour to consult with a suitably qualified sports podiatrist to discuss your condition. You can make an appointment with one of our specialist podiatrists by visiting our website at sydneyheelpain.com.au or by calling 02 93883322.

 

Karl Lockett – sports podiatrist.

References

1Alridge, T., (2004), Diagnosing heel pain in adults, American Family Physician, 70 (332-338)

2Hendrix, C. L., (2005), Calcalneal apophysitis (Sever disease), Clinics in Podiatric Medicine and Surgery, 22 (55-62).

3Pearce, C. J., Tan, A., (2016), Non-insertional Achilles tendinopathy, EFFORT Open Reviews, 1 (383-390).

4Vaishya, R., Agarwal, A. K., Azizi, A. T., Vijay, V., (2016), Haglund’s Syndrome: A Commonly Seen Mysterious Condition, Cureus, 8 (10).

 

Stretches for Heel Pain

Information about stretches for heel pain

If you have ever experienced pain in the heels of your feet, your sports podiatrist may have recommended some stretches for heel pain. Stretching is an important part of most prevention, treatment and rehabilitation programs for people that have suffered with foot and ankle complaints.

Stretches for Heel Pain

How are stretches for heel pain beneficial?

Performing stretches for heel pain can help to improve muscle strength and promote flexibility in the ligaments, tendons and muscles of the feet, helping to relieve the pain. Having tight muscles in your lower legs or feet can increase your risk of developing, or aggravate existing conditions such as plantar fasciitis, heel spurs, Achilles tendonitis, and another conditions that cause pain in the heel. Once the cause of the pain is determined and a diagnosis is made, the sports podiatrist will be able to prescribe appropriate stretches for heel pain.

What types of stretches for heel pain can I do?

The types of stretches for heel pain that will be appropriate for you will entirely depend on what is causing your pain. Once you have consulted with your sports podiatrist and they have made a diagnosis, they may suggest some of the following stretches:

Alphabet Stretch: This is one of the stretches for heel pain that is great to perform first thing in the morning, and then at any time of the day when you find a moment and you are seated. This stretch helps to loosen scar tissue, reduce inflammation and strengthen the muscles of your ankle and foot.

  1. Hang your feet over the edge of your bed, or freely off the edge of your seat.
  2. Imagine that your big toe is a pen, and use it to trace the letters A to Z in the air.
  3. Repeat for each foot.

Calf Stretch (Runner’s Stretch, Floor Stretch): Tight muscles in the feet and calves can make plantar fasciitis and Achilles tendonitis worse. This stretch helps to loosen the calf muscles to relieve the pain.

  1. Place your hands against a wall
  2. Take a step back so that you are standing about half a metre away from the wall
  3. Take another step back again with the leg you want to stretch, keeping the leg straight
  4. Keep your heel on the floor and turn your toes inwards slightly
  5. Bend the other leg lightly as you lean your body forwards. You should feel the stretch working down in the area of the calf belly / Achilles tendon in the back of your lower leg.
  6. Hold the stretch for around 15 to 30 seconds. Repeat 2 to 4 times.

If it is uncomfortable to keep your leg straight, you can begin the stretch by starting a bit closer to the wall and keeping your rear leg slightly bent.

Calf-Plantar Fascia Stretch (Seated Towel Stretch): This stretch places mechanical (external) stress on your toes, causing them to flex backwards (dorsiflexion), therefore stretching the Achilles tendon, calf muscles and plantar fascia. (can irritate / overload / prolong plantar fasciitis)

  1. Sit on the floor and have your legs extended outwards and your knees straight.
  2. Fold or roll up a towel long ways and put it around the foot you want to stretch, at about the height of your toes.
  3. With your hands just above your knees, hold one end of the towel in each hand.
  4. Using the towel, gently pull your foot back so that your foot stretches towards your body, stretching the muscles, ligaments and tendons of your lower leg and foot.
  5. Aim to hold the stretch for 15 to 30 seconds and repeat 2 to 4 times.

If one of your calves is tighter than the other, or you have pain in only one heel that makes it hard to properly stretch both legs at once, you can try stretching one foot at a time by placing the towel around just one foot.

Bilateral Heel Drop (Stair/Step Stretch): This stretch works on lengthening the calf muscles, which stretches the Achilles tendon and can therefore relieve pain in the heel over time, when performed correctly. (can irritate / overload / prolong plantar fasciitis)

  1. Start off with both of your feet on the edge of a stair or step. You should keep your balance by holding onto a handrail or another solid object.
  2. Keep your painful leg straight. Keeping the movement slow and controlled, let your heel drop to hang down off the step until you feel a slight stretch in the back of your calf and Achilles tendon area.
  3. The other leg should still be bearing some of your bodyweight.
  4. You should hold this stretch for 15 to 30 seconds and repeat it 2 to 4 times.

This stretch can also be performed with a slightly bent knee if it is initially more comfortable.

Seated Plantar Fascia Stretch: This exercise gently stretches the plantar fascia, relieving pressure and pain in the heel caused by plantar fasciitis. (can irritate / overload / prolong plantar fasciitis) – gentle stretches with a mild case when diagnosed early

  1. Sit comfortably on a chair, couch or bed.
  2. Lift your painful leg up and cross it over your knee, so that you are sitting with your ankle resting on the opposite knee.
  3. Using the hand of the same side as the painful foot, place your fingers across the base of your toes and gently pull the toes backwards toward your shin/knee until you feel a stretch across the bottom of your foot.
  4. Hold the stretch for 10 seconds, then take a break for 10 seconds. Repeat 10 times.

Towel Pick-Up: This is one of the stretches for heel pain / strengthening exercises that is simple and can be performed at any time of the day when you are seated. It is an effective exercise for stretching and strengthening the structures of the foot and ankle.

  1. Find a small towel (a hand towel works well) and place it in front of you on the floor.
  2. Sit comfortably on a chair that is the right height that allows you to sit with both feet flat on the floor.
  3. Keeping your heel on the ground, scrunch the towel between your toes and try to pick it up.
  4. Repeat the process 10 or so times for each foot. As your feet become stronger, you can progress the exercise by adding a weight (such as a can of beans) on top of the towel for resistance.

Are stretches for heel pain safe?

Your sports podiatrist will have had extensive experience with heel pain treatment and can educate you on what types of stretching techniques are appropriate for your individual condition. They will be able to instruct and demonstrate for you, the types of stretches for heel pain that are safe and beneficial in your situation. It is imperative to follow your sports podiatrist’s advice and stretch in a specific way, so as to not aggravate your condition.

 Please be aware that the information regarding stretches for heel pain detailed in the article above is intended for informational purposes only and should not be taken as general advice. You should always consult with an appropriately qualified sports podiatrist before undertaking any exercise or stretching whilst injured or during your rehabilitation. Appointments can be made online at www.sydneyheelpain.com.au or by calling 93883322.

Karl Lockettsports podiatrist.

 

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