Heel Pain, often referred to as plantar fasciitis and heel spur, is one of the most common complaints presenting to a Podiatry clinic and is frequently a more complex problem than many first believe. Plantar fasciitis is an overuse injury affecting the sole or plantar surface of the heel. A diagnosis of plantar fasciitis means you have chronic degeneration of the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes. Often patients are told that they have a heel spur. The heel spur is simply a reflection of excessive tension at the attachment of the fascia to the heel bone; there is no correlation between a spur and the onset of pain. It is the degree of degeneration of the fascia that causes the pain.

The condition starts gradually with mild pain under the heel often referred to as a stone bruise. You’re more likely to feel it after (not during) exercise. The pain classically occurs on taking your first few steps in the morning and again after a period of rest. If you don’t treat plantar fasciitis, it may become a chronic condition resulting in additional symptoms of foot, knee, hip and back problems as your walking pattern changes due to the pain.

Traditionally treatment has included ice massage, orthotics, calf stretches and sometimes Cortisone injections. Whilst these treatments may still have a place in treating heel pain, excluding ice massage, a new treatment approach has emerged that has the ability to yield faster more long term resolution of symptoms.

More recent treatments are aimed at improving the function of the supportive muscles of the foot so that the ligament is better protected and has more chance of repairing. This is important as, although the plantar fascia is one of the main supportive structures in maintaining the upright posture of the foot, there are at least 2 other muscles in the foot that have a similar role. Therefore if the plantar fascia is injured, the other structures will have to overwork and compensate resulting in over-sensitive muscles that fatigue early and develop knots (known as trigger points) further stressing the injured plantar fascia. If ignored, the cycle will continue.

A relatively new treatment that addresses this muscle dysfunction is Dry Needling (Not traditional Eastern Acupuncture) whereby a very fine acupuncture needle is inserted into the skin and muscle directly at a trigger point. The aim is essentially to reprogram the muscle, break up the knots and improve function. This is often done in conjunction with other therapies such as heat massage, joint mobilisation/manipulation and orthotics, to address the underlying cause of plantar fascia injury and subsequent trigger points.

Another treatment option is Prolotherapy, which is the injection of small volumes a local anaesthetic/glucose solution using very fine needles to promote the production and release of growth factors that can aid in the repair of the plantar fascia.

Many of the above treatment options are used in combination rather that in isolation as all of the factors affecting the healing capabilities of the plantar fascia need to be addressed including muscle and joint dysfunction, foot posture, activity levels and type and footwear.