Following on from my previous introduction article called “How to cure a foot problem”, I am now going to look at a specific foot condition that can be particularly challenging. That is heel pain, which is most commonly known as plantar fasciitis, although this is often an incorrect diagnosis for the cause of the problem. There are over 40 possible diagnoses for heel pain but many healthcare professionals do not realise this, and frequently I see patients who have been misdiagnosed by their GP, Nurse, Osteopath, Chiropractor, Physiotherapist, Sports Therapist, Masseur, Pilates Instructor etc. and therefore have been given unsuccessful or even inappropriate investigations and/or treatments.
However, let’s assume that the diagnosis is correct and it is indeed your plantar fascia (the ligament that runs along the sole of the foot) that is inflamed, hence the term “itis”. Most commonly this inflammation occurs at the insertion of the ligament into the heel bone (calcaneus), which is why it is connected with heel pain. The ligament becomes inflamed predominantly due to a spike in load that irritates the tissue. This can be as simple as from a new pair of shoes, digging in the garden, climbing ladders, or going for a longer walk or run than normal. Once irritated, the inflammation can spread to the heel bone itself causing bone oedema (swelling). The classic pattern with plantar fasciitis is that it causes often considerable pain on initial weightbearing after rest especially first thing in the morning, although other conditions can also cause this.
A good Podiatrist is able to carry out in depth assessments to provide an accurate diagnosis and develop an individualised treatment plan to help resolve the problem.
So how can plantar fasciitis be cured?
Well actually all we have to do is provide the optimal conditions for the body to heal itself. However that is more difficult than it sounds. Many of our body tissues have a zone of optimal stress (ZOOS) which enables them to function well without causing symptoms or problems. If we cause a spike of load to our tissues, then they are pushed out of their ZOOS and they become inflamed & damaged. If we don’t put enough load through them, then weakness and degeneration can occur.
Illustration courtesy of Kevin A. Kirby, DPM
As we get older and also associated with certain common medical conditions (such as diabetes), our ZOOS becomes reduced so it’s easier to be outside of the zone in the regions where problems occur. The key to resolving plantar fasciitis is identifying a patient’s ZOOS (which will be different for each individual), then keeping the tissues within that so that self-repair takes place and then expanding their ZOOS over time to help avoid recurrence of the problem. Different patients will have differing requirements to keep them in their ZOOS, but a common treatment plan at my clinic is:
Occasionally we may have to add it additional therapies such as shockwave therapy, high intensity laser therapy, steroid injections, bespoke orthotics, or mobilisations / manipulations. By having so many tools in our toolbox, my clinic has a great reputation for helping to resolve plantar fasciitis. We see hundreds of cases a year and I can’t remember the last time I had to refer a patient onto a surgeon to carry out a surgical procedure for the condition.
Thank you for reading and I hope you find the information useful. In the next article, I will show you how we cure ingrowing toenails so keep an eye out for it. In the meantime, if you require a Podiatry or Physiotherapy appointment, please call 01926 811272 or book online.
Jonathan Small, Lead Podiatrist, Health First Foot & Gait Clinic, Southam, Warwickshire, 01926 811272
“Thank you for your wonderful service…I have been in pain for a long time, unable to walk at times, not able to wear certain shoes and this has affected my whole life…within an hour of my appointment I began to feel the relief and effects of your treatment…14 days later I feel as though I have a new pair of feet! Thank you, amazing feeling!” Mr. S.M.
“I’ve been battling with planter fasciitis in my heel for 15 months, Jonathan small was highly recommended. I got no such luck from my doctor. I give these a ring and got me in straight away. Met Jonathan had a brief chat the knowledge and information given was very helpful put me on a 6 week course and my foot is the best its been in a long time. From start to finish my experience was great. highly recommend Jonathan and his staff all very friendly.” Mrs. C.H.