Plantar fasciitis / heel spurs

Pain in the underside of the heel, especially first thing in the morning

This is typically an early-middle aged problem and is fairly common. The common theory is that slight dropping of the arch due to normal age related changes induces a reaction in the heel. The foot can simplistically be viewed a bit like the Sydney Harbour Bridge. The arch is the tarsal bones and the road portion can be likened to the plantar fascia. This string thickish strip of tissue connects the heel bone to the ball of the foot and helps prevent dropping of the arch.

The reaction occurs in the heel (calcaneus) where the fascia inserts into the bone. Basically, the body does not know what to do to fix the problem, so it tries to repair the strained tissue (inflammation) or harden it up (ossification). What ensues is an alternating process of inflammation and bone formation at the site, and that is how the bone spur develops. Studies show that the process is usually self-limiting, which means it eventually settles down, but this can take an average of 9 months, with some cases lasting a year or two.

Your podiatrist can help by providing support for the arch as it goes through this ‘natural’ process. Some feet are too unusual in their structure, and a custom moulded orthotic is prescribed, but many feet can simply use a cheaper ‘off the shelf’ orthotic and get similar relief. Strapping tape can also be used with good success.

It is important for patients to understand that whatever the treatment, the process will continue until the body finds its own balance of repair and ossification, so the pain will continue to some extent. Stretching and strengthening strategies are also important in the management of this condition, and your podiatrist will help you with that. Tightness on the calves and stiff joints can also be a hindrance, so referral to the osteopath for some manual therapy is often part of the process.