Guest post by Anna Walsh – Physiotherapist
The most common cause of pain under the heel and sole of the foot is Plantar Fasciitis.
The plantar fascia is a fan-shaped piece of connective tissue, forming an inverted sling under the sole of the foot reaching from the heel to the ball of the foot. It helps to form the longitudinal “arch” on the underside of the foot. Normally, the plantar fascia gives both static support to the foot’s arch, as well as shock absorption during movements such as running, jumping and walking. With overuse, the collagen fibres which make up this fascia become disrupted and undergo cellular change. Whilst there is not any chemical inflammation as such, this collagen disarray causes tightness under the foot and commonly pain, particularly under the heel.
Pain from plantar fasciitis usually starts gradually, rather than from a single traumatic episode. Typically worse in the morning when first getting out of bed, or after prolonged periods of standing, this pain will often reduce with exercise as the foot starts to warm up. There will often then be a constant ache following training or activity. In more severe cases however, the pain may actually increase with activity and be present even with weight-bearing on the affected foot.
A foot that either pronates (“flat feet”) or supinates (“high arches”) may precipitate plantar fasciitis. This can be due to an increased strain on the plantar fascia at the heel attachment as it attempts to stabilise the arch during push off, or to absorb shock as the foot is adapting to the ground underneath it. Runners and dancers are at risk of developing this condition, as there is a lot of load placed on the plantar fascia during full plantarflexion (pointing the ankle) combined with full extension of the ball of the foot (imagine that you were rising onto the balls of your feet to peek over a high fence).
Ankle stiffness, non-supportive footwear, and excessive walking (particularly in the older person) can also contribute. Other factors are commonly seen, such as obesity and work-related long periods of standing on hard surfaces.
Physiotherapy treatment can be extremely effective for plantar fasciitis. Unfortunately, a period of resting from aggravating activities may be advised initially, along with regular application of ice-packs and stretches for the plantar fascia. A simple way to do this is to rest your toes with the ball of your foot against a low step or brick. Then keeping your heel on the ground, lunge so that your knee moves forward over your foot. Stretching tight muscles further up the leg is important, particularly the calf, as well as hamstrings and gluteals. Self-massage on the sole of the foot with a golf ball, or frozen water bottle laid flat, can be performed while standing to achieve a firm and effective massage. Techniques used by your Physio may include massage, foot mobilisation, taping, ultrasound, strengthening exercises for the intrinsic foot muscles to improve arch support, and correction of contributing factors such as poor biomechanics, muscle imbalances and running technique. Plantar fasciitis requires more than just an overnight fix, but be patient! Following good advice from your health professional will lead you on the path to a steady recovery.