You've probably heard of this condition before. Maybe you've even had it before. But what exactly is it?
The plantar fascia is a thick connective tissue that runs from your heel to front of your foot. It helps support the arch of the foot and has a role in the normal mechanics of the foot with walking or running.
The plantar fascia, just like other tissues in our body, is susceptible to overuse. That overuse can come from doing too much too fast (i.e. sudden increase in running mileage or an increase in the amount of standing you're doing) or from being overstressed because there's some other weakness, tightness or muscle imbalance somewhere else in the body.
This can cause the plantar fascia to become acutely inflamed, hence plantar fasci-ITIS or inflammation of the plantar fascia. The problem is, it often moves out of this phase and into more of a degenerative or chronic phase, plantar fasci-OSIS. You see, the name plantar fasciitis is probably used more than it ought to be. By the time patients with heel pain make it to the PT or the MD, they're probably more in the OSIS phase or the chronic phase of plantar heel pain.
Either way, this plantar fascia problem can cause SEVERE heel pain. It usually presents as sharp pain right in the bottom of the heel, maybe just a bit to the inside of the heel, that some patients report feels like you're stepping on a knife or a nail. It is typically worse first thing in the morning (or during the night if you have to get up for any reason) and after periods of sitting. It can also hurt more with long periods of time on your feet, standing or walking.
While overuse is one of the most common causes, typically there is some other underlying factor that has made it more susceptible to injury. We call that a mechanical cause. That just means there's another structure somewhere that has a lack of mobility, inflexibility, or weak or uncoordinated muscles somewhere further up the chain (up the leg). Some of those causes can be tightness in the calf muscles or ankle joint, weakness in the lower leg or foot muscles, or poor coordination of the foot and pelvic stabilizing muscles.
Can the heel pain have any other causes? Absolutely.
The problem with calling all heel pain plantar fasciitis is that heel pain can have many other causes and lots of those other causes can look very similar to plantar fasciitis. The best way to get rid of the heel pain though starts with making sure we know where the pain is coming from in the first place.
So what are some of the other causes of heel pain that can look like plantar fasciitis?
Calcaneal fat pad irritation: Everyone has a pad of fat that sits underneath the calcaneus (heel bone) that cushions the bone. This fat pad can become irritated and present almost the same as plantar fasciitis.
Nerve pain from the spine: Your lumbar (low back) spinal nerves go all the way down to the tips of the toes. If there's a problem around the nerves in your back somewhere, it can cause heel pain, even if nothing else hurts in your back!
Muscle pain: You have A LOT of little muscles in the bottom of your foot that help stabilize your foot and keep you upright when walking and standing instead of faceplanting. These muscles, for obvious reasons, are very important. If there's a muscle imbalance (weakness), overuse or strain, it can cause pain in the foot/heel.
Pain referred from another structure: Our body is weird sometimes. You can have a structure or tissue that refers pain to another area sometimes. Say what?! An example of this is a trigger point or knot in a muscle that can refer pain to another area outside of that muscle. That can be tricky when you're trying to figure out where your heel pain is coming from.
Poor footwear choices: Sometimes getting rid of your heel pain can be as simple as changing your footwear. Poor or worn out footwear can cause heel pain just like a worn out mattress can cause aches and pains when you sleep at night.
Wow. That's a lot of other stuff that can cause heel pain. So how do you know what's causing your heel pain? And how do you get rid of it?
Think about it this way, if you have heel pain and you do a bunch of self treatment directed right at your foot (massage, ice, towel scrunches, etc) but the source of the pain is coming from your spine, do you think it's going to get any better? Most likely, it won't change. A lot of people go this route and their heel pain doesn't change. We hear that from quite a few patients who end up frustrated and in our office.
That's where a physical therapist comes in. A PT is skilled at determining the cause of your heel pain. A thorough history of your pain and activities can guide us to pick different tests and measures to determine where your heel pain is coming from. That is VERY important. If you want to make the heel pain go away, you HAVE to know where it's coming from in the first place. The sooner you identify the source of your heel pain, the sooner you can change it.
Once your PT determines the cause of your heel pain, the appropriate treatments can be used to reduce the pain and correct any mechanical issues found during your evaluation (tight calves, weak foot muscles, etc). This could include soft tissue work, dry needling, joint mobilizations, cupping, etc.
You'll definitely get some exercises to do to work on the mechanical deficits and to help heal the plantar fascia (if that's the source) as well as recommendations on activities you should/shouldn't do, activity modification if needed, footwear changes and what to expect as far as getting back to your regular, pain free activity.
Once you do this, you're back on the road to doing what you love without your heel pain getting in the way! And isn't that what you want? To walk, run and just get out of bed in the morning without your heel hurting? Yeah, we thought so ;)
Do you have heel pain? Have you tried self treatment without any improvement? Well then what are you waiting for? Come see the experts at Nashville PT and let them determine the cause of your heel pain (be it plantar fasciitis or something else) and start healing it today! You can schedule your evaluation HERE.
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