Plantar fasciitis a: whats really causing your heel pain

heel pain and plantar fasciitis | Arana Hills Physiotherapy

Plantar fasciitis its the scourge of the young and old, the runners and the weekend warriors. Often we here the complaint of  ” I have a stone bruise in my heel ”  but what it turns out to be is plantar fasciopathy or plantar fasciitis as its often referred to.

Nobody likes to be off their feet so to speak. If there is one thing that really gets my back up as a physio is when patients tell me that they have been told “there’s nothing that can be done for it” when talking about an injury they have.

Plantar fasciitis / fasciopathy is more than  just a heel pain or a stone bruise.

True plantar fascia is not the fastest resolving kid on the block when it comes to responding to treatment but that doesn’t mean it’s a hopeless situation. Let’s get rid of the myths and deal with the facts shall we?

Its a multifactorial issue and is very dependent on the individual as to what is the best way to treat it and how it responds.

Age, activity levels, foot mechanics and symptom presentation will all have a role in planning the management and achieving the best outcome.

What is the plantar fascia ?

plantar fascia diagram | Arana Hills Physiotherapy

Plantar fascia (Warning Ignore spurs and microtears )

The plantar fascia is a fibrous structure that extends from the medial part of the heel and attaches to the capsule of the joints of your toes, the metacarpal phalangeal joints.

Plantar fascia can be considered part of the tendon family.

Its mainly composed of the protein type 1 collagen which is arranged along the length of the plantar fascia. Not surprisingly it has a large population of nerve endings and receptors in it, (anyone with ticklish feet can attest to that!), and interestingly it has significant muscular attachments to the intrinsic muscles in the foot.

Studies have also shown that in younger individuals there appears to be a very definite blending of the plantar fascia with the paratendon component of the achilles tendon. As we get older this elastic connection becomes more stiff  and this is probably a factor in the development of achilles or plantar fascia problems as we get older

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Nerve supply of the plantar fascia and a nerve named baxter.

baxter nerve | Arana Hills Physiotherapy

As well as the strong collagen structure of the plantar fascia there is an extensive nervous innervation of the foot.

A potential cause of plantar foot pain that can easily mimic symptoms of plantar fasciitis is compression of the inferior calcaneal nerve (ICN) under the arch of the foot. The ICN is a branch of the lateral plantar nerve on the bottom surface of the foot. The nerve is also sometimes called Baxter’s nerve. It is thought that this nerve can get irritated or compressed between the muscles and bones of the foot causing pain.

(I had a dog called Baxter who got on my nerves, the glorious idiot)

What does the plantar fascia do ?

The plantar fascia’s function in walking and running.

The main function that people attribute to this structure is related to the windlass effect. This is where the the structure quickly tightens up and locks in the small bones of the foot, essentially turning a highly mobile foot into a rigid structure to help move us forwards. This occurs as we go from foot flat on the floor to pushing off our big toe.

Plantar fascia and shock absorption.

The plantar fascia has a high content of type 1 collagen and elastin making it an effective spring like structure. There is also an intimate anatomical connection between the achilles tendon and the plantar fascia  and as such they work in tandem as a part of the shock absorbing system of the lower limb.

Plantar Fascia and position sense.

A lesser known function of the plantar fascia is its role on balance and fine coordination. The blending of the plantar fascia with the small muscles of the foot also add to its role in fine movement function and joint position sense. If the structure is painful then these functions of the foot are more than likely also affected.


What are the symptoms of plantar fasciopathy / fasciitis  ?

plantar fasciopathy symptoms | Arana Hills Physiotherapy

The following are usually symptoms associated with plantar fascia;

  • Symptoms that feel like a stone bruise.
  • Pain with weight bearing, walking or running.
  • Pain at the base of the heel.
  • Pain in the inside border at the sole of the foot.
  • Stiffness on getting up that eases as you walk more.

Differential Diagnosis and plantar fasciitis;

If pain is more persistent and doesn’t ease with rest it may be a more chronic sensitised form of plantar fasciopathy . However the following conditions may be presentations that can mimic plantar fascia or are co – existing;

  • Irritation of the inferior calcaneal nerve / Baxter’s nerve.
  • Periosteal irritation / bruising. This is the skin like covering of the bone that is highly sensitive.
  • Heel spur fracture.
  • Fracture of the calcaneous.

In our next blog we look at treatment options and exercises for heel pain

Alternatively book in to see one of us to get you back on your feet.

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