How to treat Chronic Heel Pain or plantar fasciopathy? Mr Alasdair Dall, Podiatrist at The Edinburgh Clinic explains

The plantar fascia is a broad band of dense connective tissue, similar to tendon and ligament that originates from the heel bone (calcaneus) and inserts into each of the toes, forming a fan shaped structure. It serves an important role in foot and lower limb mechanics. It is now thought that plantar fasciitis is not an inflammatory condition; it is now thought that the process is more likely a degenerative one and the literature supports this. As a result, Podiatrists and other health care providers have started to use the name plantar fasciopathy or chronic heel pain (CPHP) to reflect this change in thinking.

What are the symptoms?
Patients suffering from plantar fasciitis will typically complain of pain affecting the underside of the heel especially when getting out of bed in the morning or after sitting for a period of time. The pain may improve after a few minutes of walking but will return after prolonged periods of weight bearing activities such as standing walking or running.

What causes it?
If you are in a weight bearing occupation, are overweight or have flat feet, high arched feet or tight calf muscles, you are more likely to develop heel pain. As it is an overuse syndrome, increasing your training intensity or volume too quickly is also a risk factor.

What to do at home
Although there is little (if any) inflammation involved with this condition, ice works well as an analgesic and will help control the pain, especially if you’ve had a long day on your feet. If you are overweight, losing weight is recommended. Avoid barefoot walking and wear supportive and well-cushioned shoes such as a running shoe. This type of shoe offers arch support, shock absorption/cushioning, is light and comfortable to wear, and also allows me to accommodate an insole if necessary.  Stretch your calf muscles regularly and try and modify your activity to reduce irritating the problem.  

When to seek help
If your symptoms have not improved after a short period of stretching, self-pay or insured patients can book a consultation with an expert Consultant Podiatrist at The Edinburgh Clinic. It is vitally important to get an accurate diagnosis of your condition before undertaking any further treatment as there are many differential diagnoses for CPHP that are treated in a different manner.

How is it treated?
Some studies have shown that patients with heel pain also have weak foot muscles, so it makes sense to strengthen these as well as stretching your calf muscles. Strapping is something I use a lot in the early stages of heel, as it is a very good method of firstly reducing your pain levels and also leading my treatment plan.  Orthoses (special insoles) are generally very helpful in treating heel pain; they can be used to help cushion the heal and to reduce the forces that have caused the pain. If conservative measures fail, injection of steroid may be considered.

At The Edinburgh Clinic we have two Podiatrists, Alastair Dall and Robert McCririck, treating insured and self-pay patients from Edinburgh and across the Lothians. Learn more about our Podiatry service here or call us on 0131 447 2340 to make an appointment.
We also offer a Private GP service for self-pay patients; more here.

Date: 02/08/2018
By: Mr Alastair Dall