Overview


Plantar heel pain (PHP), previously known as plantar fasciitis, refers to rear foot pain that is often experienced on the plantar side (underneath) the foot. PHP is a condition characterised by pain and inflammation from micro-tears in the plantar fascia, a thick band of tissue that runs along the bottom (plantar side) of the foot. PHP often occurs due to repetitive stress and strain on the plantar fascia, leading to degeneration and irritation at its origin point at the heel bone (calcaneus). PHP often results from a spike in work/sport related activity, biomechanical factors, improper footwear, or underlying factors like flat feet or high arches. The pain is typically most severe with the first steps in the morning or after prolonged periods of inactivity. PHP affects a broad demographic, with a higher prevalence among middle-aged individuals, athletes, and those with certain risk factors such as obesity or occupations that involve prolonged standing or walking. Research indicates PHP accounts for approximately 10% of running related injuries and 11-15% of all foot conditions requiring treatment from physios. 

 

Anatomy 


The plantar fascia is a thick band of connective tissue located on the underside of the foot, spanning from the heel bone (calcaneus) to the base of the toes. It plays a crucial role in supporting the arch of the foot and absorbing shock during weight-bearing activities such as walking, running, and jumping. The plantar fascia originates from the medial tubercle of the calcaneus and extends forward along the sole of the foot, dividing into multiple bands that attach to the bases of the toes. This fibrous structure provides stability to the foot’s arch and helps maintain proper alignment of the bones and joints during movement, contributing to overall foot function and biomechanics.

Common Causes 

 

The leading factors contributing to plantar heel pain (PHP) are as follows:

Overuse and Repetitive Stress:

PHP frequently stems from excessive or repetitive strain on the plantar fascia, which causes inflammation. Prolonged standing, walking, or running activities can intensify this strain, especially when individuals abruptly increase their workload, such as working longer hours or increasing running distances.

 

Biomechanical Issues:

Foot biomechanics, like flat feet (pes planus) or high arches (pes cavus), can disrupt weight distribution and stress on the plantar fascia, heightening the risk of PHP.

 

Footwear Choices:

Wearing shoes lacking arch support, cushioning, or shock absorption can contribute to plantar heel pain. High heels and unsupportive shoes alter natural foot mechanics, which can worsen the condition.

 

Obesity:

Excess body weight increases stress on the plantar fascia during weight-bearing activities, elevating the likelihood of PHP.

 

Age and Activity:

PHP is more prevalent in middle-aged individuals, particularly those engaging in high-impact activities like running or jumping. Age-related changes in the plantar fascia’s structure and flexibility can exacerbate heel pain, particularly in active individuals.

 

Diagnosis 

When diagnosing PHP, your experience of how the pain started, the type of pain and location of pain will all give a good indication that PHP may be present. From here, identifying any changes in training load or daily activities is key, so we can identify the trigger of PHP and either reduce or modify the type and amount of training (running, walking, ect) that you are doing to help settle down your symptoms. 

 

We then look to confirm our diagnosis with functional testing. This involves an array of calf raise variations, pogo jumps and hops, which indicates the severity of your pain. We may then also choose to assess calf muscle length and strength, to see if these may have been contributing factors. This can be done either with muscular endurance testing or with force dynamometer testing. 

 

With this information, plus some specific orthopedic tests, a clinical picture can be created that indicates PHP is the source of your pain. 

 

Management 


An important aspect in the management of PHP is deloading or modifying the activity that may have triggered your pain in the first place. This will ensure your symptoms do not progress and worsen. Based on our assessment, we will prescribe a graded exercise loading program that focuses on strengthening the intrinsic muscles of the foot, the calf and achilles complex, the peroneals, and the tibialis posterior. This helps to strengthen the surrounding structures, offloading the plantar fascia and allowing time for the inflammation to settle. In this acute phase, manual therapy and soft tissue release can be effective pain management strategies along with foam rolling, ice and anti-inflammatories. 

 

Once the inflammation in the plantar fascia has settled, we will then progress to start loading the plantar fascia itself with exercises such as calf raises with toes elevated. Jumping exercises that are specific to your activity are then introduced, to regain the stiffness and load absorption capacity of the plantar fascia and the surrounding muscles. Once early stage jumping exercises have been completed, we slowly reintroduce running or walking, and gradually build up your tolerance to these repetitive movements. 

 

 

Taping 

Taping can be highly effective for PHP. There are several techniques that help provide arch support, which offloads the plantar surface of the foot. It is not a strategy that we look to rely on long term, but it is a great temporary solution to help get you back to doing what you love sooner!

Role for Orthotics

The evidence is divided on the effectiveness of orthotics for PHP. If the causal factor behind your pain is suspected to be hard or unsupportive footwear, adding in a pair of orthotics can help provide some extra cushioning and support to help the inflammation settle. Similar to taping however, they are not something we commonly prescribe as a one-stop-shop solution!

 

This information could be used as a guide to categorise and assist initial management of your plantar heel pain. If your questions remain unanswered, or you are suffering this discomfort without relief, reach out to us for an assessment and tailored treatment plan!