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Heel pain is the most common musculoskeletal problem seen by podiatrists. The most common cause of that heel pain is a condition known as plantar fasciitis. The problem with it being so common is that everyone is an expert on it and everyone has there own magic cure for it that they think everyone should use. There is no shortage of advice for people on how they should treat plantar fasciitis in social media, in eBooks, on YouTube and on forums. Every time you see someone ask how to get rid of plantar fasciitis you get plenty of advice of what worked for them, therefore you should try it. However, for each recommendation of a particular treatment that gets given, there is another person says that it did not work for them. Many of the treatments that you see recommended can not possibly work, but those people swear by it.

The issue is that the symptoms of plantar fasciitis always get better over the long term anyway, so did it get better because of the treatment or did it work as it was about to get better anyway? You only have to look at the placebo or no treatment groups in the published clinical trials on plantar fasciitis to see that there is always an improvement in that group. That improvement is because of natural history of the condition. This means that any treatment that does get used for plantar fasciitis really needs to have been shown to have done better than doing nothing or compared to a placebo in a clinical trial before we can say that it does definitively work.

Another way of looking at this is that if you have 100 people with plantar fasciitis and do nothing for them, then after, say 6 weeks, let say 30% of them are better naturally. What if you gave those 100 people a useless treatment? After 6 weeks with that useless treatment, 30% of them will be better because of that natural improvement. However, those 30 people will be totally convinced that the treatment worked when it had nothing to do with it. It will be very hard to convince them otherwise.

In clinical research, it will take, say 200 people and randomise them into two groups (so that each group has the same characteristics such as age, weight, duration of symptoms etc). One group (of about 100) will get the actual treatment being tested and the other group (also of about 100 people) will get a placebo or useless treatment or left alone. After the, for eg, 6 weeks, say, 30% of that placebo or no treatment group would be better, but so would 30% of the group that got the treatment being tested get better because of that natural history. What is needed in clinical research to show that a treatment works, is that is there more than 30% better in the group getting the treatment?

Can you see how treatments that might not work might appear to work by people who used them? It can be so deceptive. That is why we only use treatments for plantar fasciitis that we are confident do better than a placebo because the published scientific research tells us that they are better than doing nothing.

Do you have pain under the heel that is worse in the morning and gets a bit better after you have taken a few steps?

If you do then there is a very high probability that you have plantar fasciitis and that pain is called ‘post static dyskinesia’. While there are many other causes of heel pain and some other causes that can cause that post static dyskinesia, plantar fasciitis is by far the most common cause of the first step pain in the morning or after prolonged rest. As with all types of problems, getting the diagnosis correct before time, energy and money is spent on a treatment is important.

Plantar fasciitis is the most common musculoskeletal problem that we see at Croydon Total Footcare and it can range from a minor annoyance all the way to quite a severe disability that is so painful that doing things like going to work is difficult.

The plantar fascia is a very strong ligament like structure on the bottom of the foot that is a flat sheet connecting the heel bone to the toes, so its primary function is to support the arch of the foot. Anything that puts too much strain on that plantar fascia, such as being overweight or having high sports activity levels or being on your feet all day on hard concrete floors, can increase the risk for getting it.

Our approach to plantar fasciitis is to get the diagnosis right first and make sure that it is actually plantar fasciitis that we are dealing with. Then there some advice re the initial pain relief with the use of education, ice and maybe strapping to settle it down. Then the longer term strategy is needed. This might involve foot orthotics to prevent the load in the plantar fascia and an exercise or loading program to make the plantar fascia stronger so it can take the loads. Each approach is likely to be different between individuals and that is a discussion that you need to have with one of our podiatrists.

Heel pain in kids is something we see a lot of and something that is quite common. Ask a group of, say around Year 6 school kids, about it and you can assume that they have had it or if they have not had it one or some of their friends have had it – it is that common. The most widely used term for this is ‘Sever’s Disease’, named after Dr Sever’s who first described it. The technical or medical name is ‘calcaneal apophysitis’. At the back of the heel there is a growth plate that growth in children takes place at. The condition is a strain or irritation of that growth plate. The growing area of the bone merges with the rest of the heel bone (calcaneus) in the early teenage years, so the condition does not exist after that age.

The issue with the terminology is firstly there is a movement away from naming conditions after people, so the terms ‘Sever’s’ should probably be dropped because of that. Secondly, there is also the issue of calling it a ‘disease’ when it is not a disease. Using the word disease to describe this problem is nocebic and conjures up all sorts of images in the child’s mind so that should not be used also for that reason.

Typically, the symptoms of this condition are at the back of the heel and are worse during activity. They may be reproduced by squeezing at the back of the heel bone. While this is the most common reason for heel pain in children, there are a number of other less common conditions that will need to be ruled out and it is important to get the diagnosis right in case it is something more serious.

The cause of Severs Disease or Calcaneal Apophysitis is most likely just simple overuse; that is too much activity, especially on harder surfaces. A higher bodyweight and tighter calf muscles may also be an issue that increases the risk for this.

The typical approach to treatment after getting the diagnosis right is just reassurance of the child of the self limiting nature of this condition and load modification of activity levels and lifestyle to keep the symptoms under control. Sometime a cushioned heel raise can be used to protect the area. ICE can be used after sport to help the pain.

Pregnancy comes with significant body changes, some of which can actually take place in the feet. The added bodyweight, the fluid retention and the hormonal changes increase swelling in the foot and lower extremities, increasing the chances of foot pain and the ligament laxity may result in structural changes to the feet.

Pregnancy and Foot Swelling
There are several factors that contribute to foot swelling during pregnancy. The body produces more blood and body fluids when you are pregnant and also retains more water during the pregnancy. The venous system is also compressed as the pregnancy progresses which impairs blood flow back up to the heart. All of this leads to an increase in foot volume, leading to footwear fitting issues during the pregnancy.

Almost all of the extra fluid is lost with the birth of the child, so this problem tends to be temporary. During the pregnancy, elevating the feet and using compression/support stockings may help with the symptoms. Also, consider the Archie Thongs.

Pregnancy and Ligament Laxity
When pregnant, the hormone relaxin increases to relax the pelvis which is quite normal and is needed to facilitate the birth process. However, that hormone also affects all ligaments in the body including the foot. Combine that with the weight gain and you can see how the foot can be affected. This can decrease the arch height, increase foot pronation and increase the length of the foot. This means, a flattening foot deformity may result in other problems such as bunions, posterior tibial tendon dysfunction, as well as knee and back problems.

Foot orthotics may help protect and support the feet during pregnancy. The use of good and supportive footwear of the right size is also important. The Archies Thongs are particularly useful.

Pregnancy and Foot Pain
Several studies have shown that 40-50% of women have foot pain during pregnancy. This can range from feet that feel achy, especially while standing for long periods of time to more painful conditions, such as plantar fasciitis. The cause of these problems are mentioned above: weight gain, swollen feet and the hormone, relaxin.

The treatment of the foot pain during pregnancy will depend on the underlying cause of the pain. Please talk to your podiatrist about that.

Under the bottom of the heel is a fat pad that naturally cushions us and protects us as we walk. When walking, there is a pressure equal to about 2.5 times body weight on the heel during heel strike, so it should be obvious why we need that fat pad. Without that fat pad there would be very poor shock absorption and this can lead to a number of problems due to that poor cushioning. The most common is simply pain under the heel. This is not a common cause of heel pain, but is an important one as it can often be mistaken for plantar fasciitis and other causes. Often it is easy to diagnose as there is just no cushioning under the heel and you can easily feel the bone.

Causes of Fat Pad Atrophy

The causes are not totally clear. The fat pad does atrophy with age naturally and in some it just atrophies more at a faster rate. Some people just seem to develop this and others do not. It is not related to bodyweight issues. It can occur in a number of rheumatological problems and runners due to the years of pounding on the heel may be at a greater risk for this. Those with a higher arch foot (pes cavus) also get a displacement of the fat pad which can give a similar problem to the atrophy.

Treatment of Fat Pad Atrophy

The only way to treat fat pad atrophy is to replace the fat or substitute for the fat. This can be inserted in surgicaly or a cushioning heel pad in the shoes used that has a similar consistency to the missing fat pad. Cushioned shoes can also be used with or without extra padding. Surgically this can be an injectable fillers or an autograft using your own fat cells.

If you want to know what the best options are for you, please come in and see us.

We have been stocking the Archies Arch Support Thongs in Melbourne from the very beginning. We were one of the early adopters. They are selling like ‘hotcakes’ and walk themselves out the door. With spring here and summer around the corner, how about coming in and getting a pair. We recently had a run of ladies who were pregnant buy them and raved about them. Some are coming in to buy them before heading to Bali for a holiday. Everyone seems to have a reason for wanting a pair. Even our office manager called them “life changing”! Runners and other athletes are finding then great for recovery after a hard worksout. No one seems to be disappointed in these.

What are the Archies Arch Support Thongs?

What is special about these is that they have an arch support built into them. If you need to wear foot orthotics or something simiar, than wearing thongs for an extended period of time can be difficult, so these are a good option when the weather is warmer or you prefer to use this type of footwear. Those who do not need foot orthotics just like the comfort that the arch support feature of these thongs – they just like wearing them. Some of these users of the Archies Thongs say things that they are less tired at the end of the day.

The Archies come in a varity of sizes and colours.

archies stockists in melbourne

Archies thongs design features:

Features and benefits:

  • The Arch Support – Archies Arch Support Thongs have a similar amount of support as most off the shelf orthotics. This may help to support the foot and improve foot posture, thereby potentially reducing the strain on your feet and lower limbs.
  • Comfortable! – The orthotic / arch support found in Archies Thongs combines with a super soft, highly resilient foam to provide an unbelievably comfortable feel, irrespective of whether or not you wear orthotics or have issues with your feet making them the perfect thong to wear when out walking or as a slipper in and around the house.
  • Lightweight – The highly specialised foam material found in Archies Thongs is ultralight in comparison to other orthopaedic thongs which may result in less tired and achy feet at the end of the day, making them the perfect thong when travelling!
  • The Strap is Tight – In thongs with a loose strap, your toes claw down and you do not get the protective support from the arch like you are supposed to. The tighter strap in Archies Thongs may help to reduce toe clawing allowing you to walk more naturally.
  • Construction is one piece – As the thongs are all moulded as one you are far less likely to break the toe pole as you are in thongs with a base and plug configuration.

Croydon Total Footcare have other recommended footwear brands, so come in and see them.