Plantar fasciitis

Deep pain under the heel

Tight calves can drive plantar fasciitis, although they are not always present.  When someone comes in with this problem, they may think they need to stretch their calves, but if our assessment shows otherwise, there is little point, especially since some calf stretches can be irriating.  Plantar fasciitis can be acute in some cases where the person has done a massive run or stepped on a sharp stone as both will acutely injure the fascia, but most commonly the problem comes on insidiously and hangs around for months.

The basic theory is that the plantar fascia, which is a strip of sinewy tissue linking the underside of the heel to the ball of the foot, undergoes physical change where it inserts into the bone.  At this point the fibres of the fascia closest to the bony interface can experience inflammation and osteoblasts / osteoclasts (the cells that build and remodel bone) infiltrate the fascia which causes it to change into bone.  This is why a bone spur is often seen on xray.  In a sense, the problem can be regarded as a normal part of aging.  It is most common in people of middle age, and there is usually some dropping of the arch of the foot, so it can be seen as an adaptive change.  As such, the problem ultimately can just go away, once this adaptation is complete.  The bone spur usually stays there but is no longer painful, but it can take 6-12 months for the pain to go away.  Since the pain is usually the worst in the first few steps out of bed in the morning, we recommend wearing footwear that supports the arch, and we have a pair of thongs that achieves this that we currently sell for $55.  Soft tissue work is useful if the calves are tight, and foam roller work at home is recommended.  Direct pressure massage under the foot with a ball or bottle can be relieving, and a frozen bottle of water can be used if it is particularly inflamed.  Finally, orthotics are often prescribed, and in cases with unusual foot mechanics we refer to the podiatrist for review.