Not All Heel Pain is Plantar Fasciitis

It is summer aka “Plantar fasciitis” season. We go from spending a few months in shoes to days on end in a pair of thongs. I know some people that can hit 20,000 steps during this summer period in a day in only thongs (guilty).

But one of the issues with this is your plantar fascia doesn’t like the sudden change from shoes to no shoes. The plantar fascia is the ligament on the bottom of your foot!

It is designed to lock up the middle part of your foot during walking push off so you have a nice stable foot to walk on. It does this via the windlass mechanism which sounds more like an infomercial product. The windlass mechanism despite being cool to say is the tensioning on the plantar fascia band from your  toes extending which locks the mid foot.

BUT: It can be overloaded because of changing support under your foot suddenly. Running shoes to thongs. Supportive shoes to minimalist shoes.

It can also be injured by too much weight bearing exercise too quickly eg walking for two hours when it is used to walking for one hour.

This can be further aggravated when you have “wheel alignment” issues or bio mechanical problems from bad habits or old injuries. 

How do I know I have it?

It normally really hurts in the morning. The worst being those first few steps. If you have been sitting for a while and stand up it also hurts. If you had a big day standing or walking it will always be worse the following morning.

But that isn’t me! What else could it be?

Believe it or not there are actually over 7 different structures that can cause heel pain! Below are some questions we ask to tease out whether other structures are involved.

Does it hurt when you are driving?

For example if your heel really hurts when you are sitting or driving it can’t be your plantar fascia. You need to be weight bearing for it to hurt. 

When this is the case a network of different nerves around your heel can get stuck in tight muscles or old surgical scars.

Treating these areas of entrapment helps considerably.

Have` you had a long history of back pain or recent episodes that have finally recovered?

Yes one of the nerve roots that exits your back refers to your heel. Treating the back in this case will resolve your symptoms

Does it burn or tingle especially at night?

Again this is more likely to  be a nerve entrapment then plantar fascia

Does it hurt when you walk?

You also have a big fat pad under your heel that doesn’t like hard heel striking when you walk. It needs some TLC and a change in walking. The best thing in this situation is to come in for a digital gait assessment to work out whether this is an issue.

It could also be a muscle under your foot and or one in your calf which also can be strained but refer to your heel. 

Could I have more than one structure causing my pain at once?

Unfortunately yes. I have seen people with all 7 at once. They require different strategies for each structure. I think of it like layers of an onion . With a structured organised plan they can do really well. 

So not all heel pain is plantar fasciitis despite your next door neighbour Karen telling you that’s what it is and some reiki/ light therapy will fix it.

If you suspect this maybe you or a friend make an appointment and figure out a plan with us. You can click here to book online.