The tissues on the sole of the foot can become painful in plantar fasciitis (PF). There are often mechanical factors involved, including excessive tension in the calf. It's a common condition, responsible for almost half of the foot pain we see in clinic. Sometimes it will resolve within a couple of weeks, but in other cases it can remain for quite some time.
The name "plantar fasciitis" literally just means "inflammation of the fascia on the sole of the foot". However, research shows there's actually little inflammatory activity in PF. Fascia is the layer of tissue that sits between skin and muscle. Although fascia is present along the whole sole, pain is usually focused around the heel and the inner arch.
Signs and Symptoms
The main symptom of plantar fasciitis is pain on the sole of the foot, typically focused around the heel bone. Pain levels can vary over the day: discomfort is expected first thing in the morning and after rest. It might subside temporarily during walking. Because the action of raising the toes is painful, walking upstairs is often an aggravating factor.
The NHS recommends using a cool compress, wearing supportive and comfortable shoes, and stretching gently. Your osteopath can help you with the exercises, and provide more tailored advice.
The Science of Plantar Fasciitis
The fascia on the sole of the foot is responsible for shock absorption and supporting the arches of the foot. When walking and running, the arches are meant to flatten a little, and it's the fascia that helps them spring back. With this in mind, it's not surprising that episodes of PF can follow an increase in exercise or wearing uncomfortable shoes. High heels in particular require a lot of pulling through the fascia as the toes are bent back. Because the fascia blends into the achilles tendon, there's further pull from the calf when the ankle is held in the position that high heels require (or when the calf is tight).
Conversely, prolonged standing in unsupportive or very flat shoes can be another risk factor. People who might be more likely to develop PF include:
People with very high or flat arches
Those with a high BMI
People with diabetes
People who have a significant leg length discrepancy
Diagnosis does not require any blood tests or imaging as standard, but we can refer you back to your GP if it might be helpful.
Managing Plantar Fasciitis
As mentioned above, general advice is to ice, stretch, and limit aggravating factors. Given the relationship with the calf, your osteopath might want to work up into the leg to ease any tension coming from above. Local treatment might be focused on joint movement as well as the fascia itself. Expect your osteopath to use a combination of massage-type techniques as well as focal articulation to joints. If it appears that another area of the body is working sub-optimally and placing increased demand on the foot, this might be another area to target.
Other Causes of Foot Pain
Although this is a common cause of foot pain, it is often blamed for other things. Bursitis can also affect the heel. Pain towards the ball of the foot can be caused by a nerve, or might be a sign of arthritis. Your osteopath can examine and provide a diagnosis- no need to see a GP first.