Plantar heel pain affects 10-15% of the population with an estimation of 2 million Americans visiting a physician due to heel pain affecting their quality of life. The popular term in regard to heel pain is plantar fasciitis, though the ‘itis’ in the term refers to an inflammatory condition which is not always the case. The average duration of plantar heel pain is greater than 6 months in length, leading to a progression through the acute inflammatory stage to eventual chronic heel pain which would change the diagnosis to plantar fibromatosis or plantar fasciosis. These are terms you may see on a podiatrists prescription, however they all refer to plantar (sole of the foot) heel pain.
The plantar fascia is a fibrous structure attaching on the inside portion of your heel bone, the calcaneus, and extending to the base of each of your five toes. This creates a stabilizing ‘floor’ to the base of your foot as the tissue of the plantar fascia tensions in response to the force of your weight on the floor. This is shown below, the plantar fascia is represented as the horizontal ‘truss’ to the foot in response to the floor’s force. The force is dependent many factors; foot mechanics and foot position, speed of gait, running vs. walking, weight of the individual, prolonged standing, foot and ankle stiffness, and repetitive activities in weight bearing.
The force developed on the plantar fascia causes repetitive stress and strain it’s insertion on the inside portion or medial portion of the calcaneus. Over time this stress and strain can lead to onset of bone formation at the heel often referred to as ‘bone spurs.’ Overall plantar heel pain develops from a poor relationship between the stress on the plantar fascia and its ability to handle the intensity, duration, or frequency of the stress we place on it every day.A hallmark of plantar heel pain is morning pain, often described as a painful ‘first few steps’ out of bed in the morning, with pain reducing as the foot warms up. This is one of the reports we expect to hear in the case of plantar heel pain, along with increased pain following a full day’s worth of activity, and a reduction in pain with rest followed up by an increase in pain again when rising from a resting position.
Our physical therapists at Rose Physical Therapy strive to provide an in depth evaluation to fully diagnose plantar based heel pain by creating a differential diagnosis list. This list will include referred pain from the lumbar spine, tarsal tunnel syndrome, heel bruising, reduction in shock absorption by the fat pad of the heel, stress fracture, Achilles tendonitis, and other nerve entrapments. Our physical therapists will work hard to rule out any other conditions prior to onset of treatment for plantar heel pain.
Now for the good news! Plantar based heel pain is successful in return to pain free daily function with the use of conservative care in 90% of cases! This treatment involves the use of manual therapy including tool assisted soft tissue mobilization and joint mobilization, stretching and strengthening exercises, and the use of external structures such as orthotics or taping to reduce pain. Most individuals will also benefit from the use of a night splint to reduce the presence of morning pain. Our physical therapists recommend the Strassburg Sock for this purpose.
Plantar based heel pain, plantar fasciitis, plantar fibramotosis, and plantar fasciosis are terms that describe varying degrees of a similar condition. Plantar heel pain often reduces an individual’s ability to complete their daily tasks in a pain free manner. Heel pain can arise from several sources and an in depth physical therapy evaluation can help to find the cause of heel pain and a direction for the appropriate treatment.
Contact our office and visit our website for more information to help guide you toward managing and eliminating your heel pain!
McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain–plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(4):A1–A18. doi:10.2519/jospt.2008.0302.
Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl):S1–19. doi:10.1053/j.jfas.2010.01.001