We are a Galway-based physiotherapy clinic that specialises in treating heel pain. Heel pain or plantar fasciitis is the result of collagen degeneration of the plantar fascia at the origin (base of the foot), the heel, and the surrounding structures.

The plantar fascia plays an important role in the normal biomechanics of the foot. The fascia itself is important in providing support for the arch and providing shock absorption. Despite the diagnosis containing the segment “itis,” this condition is notably characterized by an absence of inflammatory cells.

There are many different sources of pain in the plantar heel besides the plantar fascia. Therefore, the term “Plantar Heel Pain” serves best to include a broader perspective when discussing this and related injuries.

Causes

Causes of plantar heel pain are often due to a repetitive strain causing micro-tears of the plantar fascia but can occur as a result of trauma or other multifactorial causes. There are many risk factors which contribute to plantar heel pain including but not limited to:

• Loss of ankle dorsiflexion (talocrural joint, deep or superficial posterior compartment)
• High arch OR flat feet deformities
• Excessive foot pronation dynamically
• Impact/weight-bearing activities such as prolonged standing, running, etc.
• Improper shoe fit
• Elevated BMI > kg/m2
• Diabetes Mellitus (and/or other metabolic condition)
• Leg length discrepancy
• Tightness and/or weakness of gastrocnemius, soleus, or achilles tendon

Symptoms

• Heel pain with first steps in the morning or after long periods of non-weight bearing
• Tenderness to the anterior medial heel
• Limited dorsiflexion and tight achilles tendon
• A limp may be present or may have a preference to toe walking
• Pain is usually worse when barefoot on hard surfaces and with stair climbing
• Many patients may have had a sudden increase in their activity level prior to the onset of symptoms

Treatment

The condition can be disabling if not appropriately managed. An important tool is education:

• Patients must understand that symptoms may take weeks or even months to improve (depending on circumstances of injury).
• Patients should follow the advice given (e.g. rest from aggravating activities initially, ice, stretch).
• Patients should be aware of the importance of a home exercise plan.

Common treatments include: stretching and strengthening of the gastrocnemius/soleus/plantar fascia; orthotics; ultrasound; iontophoresis; night splints and joint mobilization or manipulation.

These treatments can be provided by your physiotherapist. It is important to get a correct diagnosis before starting into exercises. Your physio will give you exercises specifically designed to treat the condition without putting you at risk of injury aggravation. Here at West Coast Physio we are more than happy to talk to you about your injury and kickstart you on the road to recovery.