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This is a painful condition resulting in pain under the heel. It is often caused by overuse of the plantar fascia or arch tendon of the foot. We explain symptoms, treatment, exercises, sports massage and more.
The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. It is also known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.
The condition is traditionally thought to be inflammation. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone).
Symptoms of the condition include heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia. There can be pain when pressing on the inside of the heel and sometimes along the arch. The pain is usually worse first thing in the morning as the fascia tightens up overnight and after a few minutes it eases as the foot gets warmed up.
As the condition becomes more severe the pain can get worse throughout the day if activity continues. Stretching the plantar fascia may be painful and sometimes there may also be pain along the outside border of the heel. This may occur due to offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.
Tarsal tunnel syndrome symptoms can be very similar. If you have any shooting pain or tingling / numbness then consider this as an alternative diagnosis.
Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping. Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the fascia.
The most common cause is very tight calf muscles which leads to prolonged and / or high velocity pronation of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength
Some practitioners think overpronation can always be determined by the dropping and rolling in of the arch. This is not always the case. Sometimes it can only be seen with foot scans, especially if the patient has a high arched foot.
Other causes include low arch or high arched feet (pes planus / cavus) and other biomechanical abnormalities including oversupination which should be assessed by a podiatrist / physiotherapist / biomechanist.
Excessive walking in footwear which does not provide adequate arch support has been attributed. Footwear for plantar fasciitis - both prevention and treatment - should be flat, lace-up and with good arch support and cushioning.
Overweight individuals are more at risk of developing the condition due to the excess weight impacting on the foot.
Although there is no single cure, many treatments can be used to ease pain. In order to treat it effectively for the long-term, the cause of the condition must be corrected.