Plantar Heel Pain

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Jess Bell, Lucinda hampton, Kim Jackson, Tarina van der Stockt and Habibu Salisu Badamasi

Introduction

Plantar heel pain, also known as plantar fasciitis or fasciopathy. Differentiation between terms is important because there is a number of causes that can cause or contribute to the heel pain and not all of them relate to the fascia.

Plantar heel pain is most common in middle-aged women. The reasons for the high incidence in women are not known, however, it has been linked to early menopause. The hormonal changes are believed to attribute to a weakening of the fascia and maybe an increased stress.

The symptoms of plantar heel pain are in middle-aged women are associated with:

• Prolonged standing
• Recent changing of shoe wear
• Stress

The pain tends to be particularly bad in the morning causing the patient to struggle when they get out of the bed and start their day.

Patients usually use the internet to look up for education, advice and remedies for their symptoms. Some patients we see at the clinic may have tried strapping, rolling the foot on the ice bottle, rolling it on golf balls, and doing various stretches. And often they would say these treatments have been particularly painful, but they haven't made a difference to the pain. This drives patients to look for professional advice.

If we look at the literature, there are some pretty good studies showing that physiotherapy will have positive benefits on plantar heel pain. HOwever, when it comes to the clinical practice, different measures should be considered to apply research findings properly and see positive results. Often, the treatment that works for a woman might differ from the treatment that works for a man. The level of activity is an important factor as well as the patient's history. Considering individual factors and using clinical reasoning skills are mandatory when it comes to the treatment of plantar heel pain and other MSK issues.

Assessment

Subjective Assessment

Pain Location. Physiotherapists are skillful at figuring out the source of the pain. In other words the pain driver.

Pain Behaviour: It is important to understand the nature of the pain to get an idea of the main contributing factor. The pain can be neural or mechanical Also, ask questions to investigate the pain pattern across the day and the aggravating and easing factors.

Allowing patients to talk about their pain can be very insightful and we can help us recognize catastrophizing behavior which is common in chronic pain patients.

One of the useful motivational interviewing tips is to give your patients time to reflect on what they said. Try and summarize what they told you to understand the impact on the quality of their life.

Objective Assessment

Assessment of gait and movement:

Things to observe:

Foot, lower leg and the entire kinetic chain.

Posture-related problems such as leaning backward and shifting the weight to the ankles during gait or if the weight is mostly on the toes.

The shape of the foot e.g. collapsed arch on one side. You can link the history of trauma from the subjective assessment to the findings on observation.Also, compare the foot shape with the other foot, a bilateral collapsed arches will be treated differently from somebody that comes in with steep thick high arched feet.

Aska bout and examine orthotics and footwear. The shape of footwear and the level of comfort they experience with.

Things to observe during gait:

Overstriding

Short strides

Pounding or heavy throbbing on one side

Slapping with the foot

Walking with inverted foot/feet

Neural examination is also recommended. Some patients might describe some kind of bizarre pain which might be in different locations often disregarded because the main concern is the foot pain. Therefore, neural dynamics should be included in your assessment (Alshami)