Plantar heel pain is most common in the 40 to 70 year age group and affects women more than men. It is reckoned that 10% of people will experience it at some stage in their life. The most common cause of plantar heel pain is plantar fasciitis and this occurs when the plantar fascia (a strong ligament on the sole of the foot) is under tension for a long period. The common causes are flat feet, stiff big toes, short calf muscles, weak deep foot muscles and being overweight. Some people will have all the above causes while others may only have one.
The symptoms are pain under the heel particularly first thing in the morning, getting up after sitting and after prolonged walking or running and tenderness on palpation. If these symptoms do not describe your problem, then it is probably not plantar fasciitis.
Investigations are rarely needed unless your physiotherapist suspects it is not plantar fasciitis. When investigations are done, they will often show a heel spur but this is not the cause of the pain. It is a result of the prolonged tension and finding one on a scan does not change the treatment which makes it irrelevant.
Treatment will focus on the above causes and will usually start with calf stretches, foot muscle strengthening, mobilisations or stretches for the big toe and advice on footwear and weight loss. Orthotics may be prescribed but usually only if the pain is not settling or the feet are particularly flat. Sorting out the morning pain is essential to getting this better and your physiotherapist would advise you on a particular type of massage to use first thing in the morning. If this does not help the morning pain, you would be advised to get a night splint. Shockwave therapy can be very helpful and is usually three or four sessions at one week intervals.