09 Oct Spring Is… Plantar Heel Pain Season
The sun is shining, birds are chirping and that wonderful smell of freshly cut grass is in the air. Spring has sprung!
With this change in weather you’ll probably be eager to get out and enjoy it. Morning walks to grab a coffee, taking the dog for a walk down to the park and taking advantage of the extra daylight hours will all be at a premium.
And if you’re like me and have put on a bit of extra weight, you’ll be eager to start shedding those winter kilo’s with an extensive exercise routine.
It is also around this time of year that we start to see a lot of Plantar Fasciitis (Better known as Plantar Heel Pain, but I’ll explain this shortly). So, what is it and why do we get it?
What is Plantar Fasciitis/Plantar Heel Pain?
Let’s start by breaking down some of the common myths surrounding the appropriate term to describe this condition. The suffix ‘itis’ refers to the presence of inflammation within a tissue. Many studies using Ultrasound, MRI and tissue biopsies have shown that in many cases of “Plantar Fasciitis” there are little to no signs of inflammation within the plantar fascia.
Oh, so it must the Heel Spur?
Incorrect. Many studies have looked at the correlation of heel spurs and plantar fascia pain and symptoms. These studies have found poor correlation, concluding that heel spurs are a common incidental X-ray finding and are not related to the experience of heel pain.
So, what is it exactly?
Well the reality is that there could be a number of different reasons and accurate diagnosis for your plantar heel pain. These can include:
- Plantar Fasciopathy
- Quadratus Plantae Overload
- Abductor Halluces Overload
- Heel Spur Syndrome
- Subcalcaneal Bursitis
- Baxter’s Nerve Entrapment
- Medial Calcaneal Neuritis
- Tarsal Tunnel Syndrome
- Calcaneal Bone Oedema
- Calcaneal Stress Fracture
- Fat Pad Atrophy/inflammation
- Partial or Complete Plantar Fascia Rupture
- Other underlying conditions such as Rheumatoid Arthritis, Psoriatic Arthritis, Gout, Infection, Fibromyalgia among many others.
The reality is there is just so much complex anatomy around the heel that the diagnosis might not be as straight forward as we think. For this reason and until we can accurately assess it as being related to one or a number of the above causes, we refer to it as the blanket term, Plantar Heel Pain.
So now that we’ve got the semantics out of the way, let’s talk about why we might get it.
So, who gets Plantar Heel Pain
Those considered to be sedentary are at greater risk. This may be partially due to associated weight gain and decreased capacity of the plantar fascia and strength of the plantar intrinsics. Think of what happens to many of us over the winter. We’re more sedentary, our muscles get weaker and we often gain weight.
Believe it or not, our feet have memory. Most of their soft tissues will become as strong and as capable as what we do to them consistently. They get angry when we shock them and throw something at them they’re not used to. If we get a new pair or shoes, change jobs or increase our exercise, our feet can’t remember doing this and will often tell us that they’re not quite used to it. For example, some runners can experience plantar heel pain if there is a rapid or significant change in their training such as volume, speed, surface and footwear.
Due to the extra forces which are being placed through the foot and the Plantar Fascia , being overweight or gaining weight can increase your risk of developing plantar heel pain.
The Overweight but childbearing
Pregnancy not only causes an increase in body weight, but with all that relaxin floating around the system, the ligaments of the feet become more flexible, meaning the muscles have to work harder to help stabilise all the joints of our feet.
The Genetically Unlucky
Everyone is born unique! Your parents pass on many many traits, whether they be good, bad or unfortunate. One of these is the joint and bone structure of your feet. The shape, alignment and physical make up of your feet can be a contributing factor in heel pain.
The Vocationally Overloaded
We see a trend of patients with Plantar Heel Pain who have jobs requiring them to have extended periods of time weight bearing and/or in poor footwear. Tradies, factory workers, hospital staff and hospitality workers all fit into this category.
The Youth Deficient
Unfortunately, aging is the illness that we all live with. It slowly decreases the strength of our bones, ligaments and muscles, leaving us prone to injury. Although all age groups can be affected, it seems that those over 50 years old are at a slightly greater risk of experiencing Plantar Heel Pain.
Those suffering mental health problems
The link between your head and your feet is closer than you think. Depression, stress, and anxiety have all been found to be linked with plantar heel pain. This is most likely due to the physical changes often accompanying those with mental health problems, but also a change in how the body responds to pain and stress. Plantar Heel Pain is so debilitating and significantly affects a person’s Quality of Life that it’s rare to find a case of chronic heel pain that doesn’t affect their mental health.
So, why is Spring the Season of Plantar Heel Pain?
We see a lot of heel pain not necessarily presenting, but dating back to the Spring months. This is due to a combination of the risk factors outlined above.
We might put on a few extra kilograms and our bodies decondition over the winter. Reduced daylight hours and activity leave us more susceptible to depression and other mental illness.
Then we eagerly start our new exercise routine searching for that summer body. We change our footwear, throwing the winter boots to the back of the cupboard in exchange for flats, sandals and thongs. But, all the feet remember is what you’ve done over the winter, and they don’t cope with all this new stress placed on them.
We don’t often see people in these initial months.
A. Because it can take some time for the gradual degradation of the plantar fascia.
B. People think it will “just get better”. This is the catch cry we often hear when people present after months and months of heel pain that they haven’t been able to shake.
Note: Please know it might not “just get better”, and Podiatrists can be really helpful in addressing a lot of the causes of your heel pain and getting you on the road to recovery.
Next time you hear from me, I’ll give you some really good ways to manage and treat your plantar heel pain in the initial stages, so hopefully you don’t have to see anyone.