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Plantar heel pain (plantar fasciitis)

Sometimes referred to as: Plantar Fasciitis, Policeman’s heel, heel spur syndrome

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What causes pain under the heel?

Pain under the heel is one of the most common problems encountered in Podiatry and can be tricky to manage. The wider medical community, and the internet frequently use the term plantar fasciitis.

The plantar fascia is a connective tissue that runs through the medial arch (the bottom/sole) of the foot and connects the heel to the forefoot (ball of foot/ base of toes) on the bottom (or plantar) aspect.

Plantar fasciitis in our opinion has become more of an umbrella term for pain under the heel (or plantar heel pain), however often the problem is not actually “fasciitis” which literally means inflammation of the fascia.

Usually, we discover the fascia is more than just inflamed but is in fact thickened or abnormal (fasciosis) and sometimes we discover that there may have actually been a little tear or injury, or even a rupture.

We also often find that the heel bone can be a problem (bone oedema or swelling) and the fatty padding under the heel as well as the plantar heel bursa can also be adding to the situation. See also Heel Spur.

Sometimes the middle of the plantar fascia is painful too. This can be a sign of a wider fascia problem or even something called a plantar fibroma which is a thickened lump adjacent or within the plantar fascia.

How can I help myself?

If the problem developed gradually and tends to be worse after sleep or sitting but eases as you walk a little bit, you may find that rolling your foot on a soft ball, like a tennis ball whilst sitting down, for 5-10 minutes several times a day may help. You could also try rolling on a frozen or cold bottle, but keep a thin sock on to protect your skin from the cold. Do not do this if it causes pains or problems.

Anti-inflammatory or pain reliving medication may also be useful. Please see important safety information. 

Resting in the early stages may allow the area to heal and prevent the problem becoming more chronic. Heel cushions or insoles may also help symptoms and trainers, like running trainers, may offer more support too.

Gentle calf stretching may also be useful, and we know that strengthening and loading work shows longer term benefits in the rehabilitation of the plantar fascia too.

We will look to post some videos on exercises for plantar fasciitis soon.

Heel pain does usually improve with time, but a podiatrist will be able to help you along the way.

When to see a Podiatrist?

It is always worth having an assessment by a podiatrist to get checked over as plantar heel pain can be a very stubborn problem and can take a long time to heal. It can also reoccur, so if you get it once but it goes away quickly, you may get it again in a few months and find it’s worse and lasts longer.

A podiatrist will be able to give a diagnosis and offer advice on footwear, activity modification and exercises you could be doing. They will also be able to assess your foot mechanics and advise if you need any further treatments such as foot orthoses/insoles.

If the problem is already more serious and chronic, many podiatrists can offer further treatment options too which may include imaging or scans if needed, bespoke foot orthoses (orthotics/insoles), steroid injections and shockwave therapy.

If your pain came on very suddenly or you have significant pain and swelling, palpable lumps or an inability to put weight on the foot/heel, we recommend you rest and see someone as soon as possible. If this is severe, you may need to go to A and E but it is probably a good idea to get an appointment with a podiatrist too for further assessment.

If you book an appointment, it is wise to take the footwear you wear on a daily basis and any sports or exercise specific footwear you use too.

See Also:

Fat Pad Atrophy

Heel Bruise

Heel Bursitis

Heel Spur Syndrome

Calcaneal Fracture

Arch Pain If pain is more into the arch of the foot (perhaps the mid portion of the plantar fascia)

Baxter’s Neuritis

Achilles tendon pain If the pain is more at the back of the heel or going up the back of the leg.

Posterior Tibial Tendon Dysfunction If the pain is more on the inside of the foot/ankle.

Plantar heel pain