Heel Pain, a case of planta fasciitis
Heel Pain (Planta fasciitis)
Louise was one of my favourite patients to treat, she was an energetic 55-year-old with a passion for Zumba and suffering with heel pain. She came to see me having not done Zumba for 2 months. She felt low in mood, Zumba was her release, the music, the dancing, her group of friends and a great teacher. She’d been going for many years and she even had her annual Zumba weekend in Mallorca coming up which she didn’t want to miss.
Not aware that such a thing existed (A Zumba weekend!) I had to find out more and see how I could help poor Louise.
Louise had presented with a typical picture of heel pain. It had started about 6 months ago, it was only slight at the time and not really stopping her from doing anything. The pain felt like it was on the inside of the heel, initially like a stone in the heel until gradually it was too painful to even walk on.
She had tried massaging it and rested from Zumba (she had got to a stage where she had to stop) but it was now even affecting her walking. The mornings would be the worst when she couldn’t put he foot down for about half an hour. She felt like she was getting old and was upset that she couldn’t exercise.
This pattern is how planta fasciitis starts, it generally starts quite manageable but unless you get on top of it, it can be a very difficult condition to treat.
Firstly, I think its difficult because we wait until its too late before we try and manage it and secondly, it’s hard to stop being on your feet so once its aggravated just being on it can aggravate things more.
What is planta fasciitis?
Your planta fascia is the structure at the base of your foot, it acts like an elasticated hammock from your heel bone to your big toe. Every time you place your foot to the floor the hammock gently controls your body over the foot to give it the bounce it needs to push off through your big toe.
This hammock is made from stiff muscle type material and is very strong, like many layers of woven rope, but if there is too much pressure through the foot then it can get injured. This normally comes after you add in jumping (9x your body weight through your foot) or running.
The injury can start off as minor but as you keep doing the jumping or running then it will build to the point that it will stop you.
The other common scenario that I see if during the summer months when you can spend many hours in flat shoes or flip flops and that lack of support on the feet on the hard surfaces can also trigger heel pain.
Poor Louise was in pain and frustrated so what could we do to help?
Physiotherapy for plantar fascia consists of the following:
• Deep massage on the plantar fascia
• Stretching for the calf muscle and foot
• Wearing trainers rather than shoes/ wearing slippers or supportive shoes at home
• Keeping your feet warm
• Strength work for your foot muscles and calf
• Advise on necessary support for your feet (some evidence to suggest orthotics may help)
Advise on what you need to do daily to start with include;
In my experience, what is needed is all the above and time with the biggest factor of coming off all the activities that aggravate things mainly walking. You also need to be rigid with your programme.
If things don’t seem to settle over 4-6 weeks, then your next options are:
• MRI or Ultrasound to confirm diagnosis
• Exclude any other cause such at heel stress fractures or OA changes in your heel joint.
• A cortisone injection maybe beneficial to reduce the symptoms and allow you to get started on your rehab.
• Shockwave therapy
Louise had an injection which was beneficial but as she was adamant to get back to Zumba, the pain gradually returned, she was able to manage it better but opted for the shockwave as well after 3 months.
It is safe to say that Louise will have to manage her heel pain. We had to look at the number of classes that the heel can cope with and be quite strict in how many she does a week. It also helped to give her 2 days recovery from the impact work, which made a big difference.
Louise is not pain free but is able to do her Zumba and did go on her Zumba weekend. I think the wine may have helped with the pain relief!