Heel Pain Photography

HEEL PAIN (PLANTAR FASCIITIS)

Plantar Heel Pain (PHP) formerly referred to as Plantar Fasciitis is by far the most common condition that presents to a podiatrist office and a very, very common problem in sports medicine. Plantar heel pain is still heavily associated with the thick, fibrous band known as the plantar fascia however, the latest research studies now tend to emphasise the involvement of other structures such as fat padding, nerve roots, muscle, tendon and bone. 

The plantar fascia is very important as it creates and maintains stability in the arch. When the big toe is extended upward, the plantar fascia is tightened, achieving a rigid lever for pushing off and thus movement forward. 

A very important structure that is involved with plantar heel pain is the fat padding that overlays our heel bone. This fat padding is designed to protect the heel bone and protect the underlying structures, one of which is the plantar fascia. If there's a problem with the way this fatty tissue or padding transmits shock, in other words, it doesn't dissipate the energy quite as well, then pain is felt due to compression and shear loading experienced with everyday movement on our feet.

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At 4th week after treatment, the thickness of plantar fascia increased. Then it decreased gradually, but not to the baseline at 12th week. On the pain level outcome at 12th week, extracorporeal shockwave therapy (ESWT) was more efficient than corticosteroid injection (CSI) on chronic plantar fasciitis. The more change of plantar fascia after ESWT, the more efficient on clinical outcome.
— Lai TW, Ma HL, Lee MS, Chen PM, Ku MC. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial. J Musculoskelet Neuronal Interact. 2018 Mar 1;18(1):47-54. PMID: 29504578; PMCID: PMC5881128.

References


1.    Landorf, K. B., & Keenan, A. M. (2013). Efficacy of foot orthoses for the treatment of plantar heel pain: A systematic review and meta-analysis. British Journal of Sports Medicine, 49(19), 1181-1186. doi:10.1136/bjsports-2013-092752

  • This systematic review and meta-analysis evaluates the effectiveness of foot orthoses in treating plantar heel pain. It concludes that foot orthoses, particularly custom-made orthotics, can provide short-term relief and functional improvement in patients with plantar fasciitis.

2.    Irving, D. B., Cook, J. L., Menz, H. B., & Factors associated with chronic plantar heel pain: A systematic review. Journal of Science and Medicine in Sport, 18(6), 705-709. doi:10.1016/j.jsams.2014.09.012

  • This systematic review examines various factors associated with chronic plantar heel pain, including the effectiveness of orthotic interventions. It suggests that foot orthoses, both custom and prefabricated, can be beneficial in reducing pain and improving function in individuals with plantar fasciitis.

3.    Rasenberg, N., Riel, H., Rathleff, M. S., van der Heijden, R. A., & Witsenburg, M. (2018). Effectiveness of foot orthoses versus corticosteroid injection for plantar heel pain: The SOOTHE randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy, 48(6), 447-458. doi:10.2519/jospt.2018.7972

  • This randomized clinical trial compares the effectiveness of foot orthoses with corticosteroid injection for plantar heel pain. The study found that both interventions resulted in similar improvements in pain and function, suggesting that foot orthoses can be an effective non-invasive treatment option.

4.    Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., . . . Godges, J. J. (2014). Heel pain—plantar fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33. doi:10.2519/jospt.2014.0303

  • This clinical practice guideline provides recommendations for the management of plantar heel pain, including the use of orthotic interventions. It highlights the potential benefits of foot orthoses and suggests considering them as part of the treatment plan.

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