Perhaps the most common problem we encounter as Podiatrists at The Pedaler is heel pain. 'My heel hurts when I get out of bed'. 'It hurts when I get up for a coffee'. This type of pain is synonymous with our old friend 'Plantar Fasciitis'. A name that looks as painful to pronounce as it is to deal with. It's pronounced 'fashy-i-tis'.
Plantar Fasciitis (often termed heel spur) is the most common pathology effecting the foot. Approximately 10% of the population will experience pain under their heel in their lifetime with women more likely to suffer from the condition then men. The highest risk category are those between the ages of 44-64 who spend prolonged periods on their feet. Obesity is also closely linked to the presence of heel pain. The term 'heel spur' is often used in place of Plantar Fasciitis, however there is little evidence to support the link between the two. Heel spurs are quite common in the ageing population without the presence of any heel pain. Again, the link between the development of heel spurs and obesity is tightly linked.
The pathophysiology of Plantar Fasciitis is not pure inflammation as the name would suggest. Essentially, the plantar fascia is subjected to enormous repetitive loading over our life times and becomes damaged through micro trauma (tears). This hinders the structural integrity of the tissue often leading to enlargement, collagen disruption and pain. Due to this often non inflammatory process, the term fasciosis is often used rather then fasciitis. Either way, it still hurts.
Despite being an enormously common condition, a treatment outcome for Plantar Fasciitis is notoriously fickle. Anyone who professes to have a blanket solution to Plantar Fasciitis across the population is treading dangerously close to selling snake oil. Each case of heel pain needs to be taken on its individual merits. An understanding of the patient's risk factors needs to be taken into account and realistic expectations need to be set out. Far too often, the magic pill of orthotic therapy is wheeled out and its failure is often related to missing the other key components of a comprehensive treatment plan.
To this end, if your heel hurts, we need to get a full picture of your presenting complaint. This will translate into a thorough treatment solution not limited to orthotic therapy. With the right tools, a conservative option will lead to gradual success. If it doesn't, then the less conservative treatment options tend to get a little 'uncomfortable'. Come have a chat with us about your heel pain today.