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Heel pain - plantar fasciitis

Updated: Feb 4, 2021

Plantar fascia:

It is a white band of tissue running from the heel (calcaneus) to the balls of your foot (metatarsals heads). The fascia supports the sole and maintains the foot's arch.

plantar fasciitis

What is plantar fasciitis?

Plantar fasciitis happens when the plantar fascia is subjected to microtrauma and becomes inflamed under stress. It can be caused by an acute injury, e.g., sudden excessive loading of the foot. Plantar fasciitis is often due to chronic overuse, e.g., endurance running results from the plantar fascia's repetitive microtears.

What makes us more prone to plantar fasciitis?

  1. Excessive pronation: when we walk or run, the foot pronates (rotates inwardly) when it strikes the ground. When there is extra pronation (inward rotation)/people with flat feet, there will be an additional force in the inner foot and cause increased strain on the plantar fascia.

neutral, pronation and supination of foot

  1. High arch foot: usually is at risk because a tight plantar fascia is usually present in this type of foot.

  2. Tight Achilles tendon: it limited the ankle joint's flexibility and eventually caused extra loading to the plantar fascia.

  3. Overuse: distance running, prolonged standing/walking in daily activities strain the plantar fascia.

  4. Obesity

  5. Sudden increase intensity of training/hiking mileages.

Signs and symptoms of plantar fasciitis:

Pain at the inner side of the heel and radiates down along the inner side of the sole. There may be localized tenderness and swelling near the plantar fascia's attachment (under and the heel's inner side). Pain is particularly intense when taking the first few steps in the morning. When you band your toe upward, there may be pain along the foot's arch, or you can palpate a tight plantar fascia.

One common misconception of heel pain:

A high proportion of patients with plantar fasciitis may present bone spurs when examining in X-ray. 83 out of 109 plantar fasciitis patients present heel spurs in one study. However, others reported only 5% of patients with heel spur complaints of foot pain. Therefore, heel pain is not necessary due to bone spurs. Therefore surgery to remove heel spurs is not the only option.

Treatment of plantar fasciitis:

  • Ice (15 mins x 3 times per day) for acute pain and swelling.

  • Stretching the tight calf muscles and plantar fascia. (stretching 3 times/per, 3 repetitions each).

plantar fascia stretching

  • Choose a proper in-shoe orthotic with healthcare professionals' help for flat foot or high arch foot.

  • Taping can be considered for overpronation.

  • Choosing suitable hiking boots, e.g., with good shock absorption.

  • Surgery is rarely necessary.

This article is not intended to replace medical advice. Seek professional help if you encounter any problem with the condition.

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