Plantar fasciitis – aka heel spur or policemen’s heel

Plantar fasciitis, heel spurs, policeman’s heel are names for a condition commonly seen by podiatrists in the clinic. It can occur in all sorts of people from active to sedentary, the most common age group being 45 onwards.

The plantar fascia consists of a band of tissue (tendon) that extends from the heel (calcaneus) and splits into three parts as it approaches the forefoot. The tension that is exerted on these bands can lead to a micro tearing from the heel bone. This tearing is painful on weightbearing, but settles once up and about. The feet are often sore in the mornings, and after sitting for a while it hurts when standing. The end of the day can be particularly uncomfortable. This repeat tear (pain-weightbearing) – relief (rest-sitting , sleeping) may continue for some time, and gradually get worse unless the cause can be determined.

The causes are unique to the individual. In a sportsman, it may be related to footwear, stretching technique and conditioning. In and older person it may be related to weight gain, changing from heels to flats, unaccustomed exercise. It can also be purely biomechanical. Flat feet, excess pronation, knock knees, tight calves, hypermobility may be some of the reasons behind the problem.

It is important to catch this condition early, as it can get worse over time. Even to the extent that one can be reluctant to walk. Chronic or long standing planar fasciitis can become heel spurs. This is a bony outcrop that extends along the fasciia. The spur itself is not the problem, it is more of an indicator as to how severe the condition is.

I trust that your GP will refer you to a podiatrist, as the medicinal approach ie: Non-Steroidal Anti-Inflammatories, may make you feel better in the short term, but the tendancy is for the condition to resurface worse overwhelming the effectiveness of the pills. Corticosteroid injections are often useful for pain relief, but as with the anti-inflams the condition can overwhelm it, emerging worse than before. Physical therapies like ultrasound, massage, acupuncture, shockwave therapies – all have short term benefit if used in isolation. These treatments are more useful if used in conjunction with causal treatment. ie: deal with the root cause.

Podiatrists are well suited to treating this condition in its earlier stages as we can identify the cause, advise improvements and get a quick response. More advanced conditions may need additional intervention to assist recovery.

There are many options listed on the internet that point towards solutions, I personally do not advise the cheap and cheerful route and it can be a waste of money. Cheap insoles are not for everyone, and the insole is not the only solution. It is a multifactoral problem that needs an experienced consultant to work out the best route for you. Many companies will sell cheap insoles with promises of money back guarantees, I wonder how they stay in business. You only get one pair of feet, why mess with them.

Once we have worked out the site of your problem, discussed lifestyle and footwear, examined your individual structural mechanics, foot posture and gait. The treatment options will be revealed.
These can take the form of stretching exercises, foot mobilisation (manipulation), footwear changes, weight loss advice, insoles or orthotics, physiotherapy or home physio (techniques you can use at home), marigolds therapy for pain, sport taping, kKinesiotaping .

A biomechanical assessment tells us what foot structure you have, foot and leg alignment, muscle imbalances, leg length discrepancies. How you stand and walk, the shoes you wear, how much weight you carry, your occupation, sport are all taken into consideration.

Streching programmes to loosen muscles, in addition to footwear advice, insoles or orthotics are part of the podiatric treatment. Early intervention results in quick relief. More advanced cases take more time to recover but can be sped up with home physio, massage. marigols therapy applied to the area with a pad can be effective in immediate pain relief. Foot mobilisation is a manipulative technique that is useful in some cases, read more about plantar fasciitis.