Plantar Fasciitis Treatment in Melbourne

1 of 8 · Symptoms

Who Benefits & Common Symptoms

The hallmark is sharp, localised pain at the inside front edge of the heel, worst on your first steps of the morning or after sitting, then warming up with walking. Pressing a thumb into that spot usually reproduces it.

Pins and needles, numbness, burning, or pain travelling up the inside of the ankle point elsewhere, and separating those is a large part of the first visit.

• Sharp heel pain on your first steps of the morning
• Pain returning after long standing or at the end of a run
• A tender, well defined point at the inside front of the heel
• Aching that spreads forward into the arch
• Flares the day after a hard session rather than during it
• Discomfort barefoot on hard floors, relief in a cushioned shoe

2 of 8 · Other causes

What else could be causing the pain?

Heel pain is not always plantar fasciitis. In some instances our podiatrists may find something else is co-existing with it or creating the symptoms you're experiencing. These are the other conditions our podiatrists will screen for on the day of your appointment.

• Baxter's nerve impingement
• Heel spur
• Plantar fibroma
• Flexor digitorum brevis (FDB) muscle strain
• Plantar fascia tear
• Bone stress response
• Fat pad impingement

3 of 8 · Causes

What Causes Plantar Fasciitis?

Plantar fasciitis is a load problem before it is a structure problem. Push past what the tissue can adapt to and it becomes irritated, which is why the story is usually a change rather than an injury. Both a mobile flat foot and a rigid high arched foot can overload the fascia, through different mechanisms.

1. 01A recent spike in running volume, intensity, hills or speed work
2. 02Long shifts standing or walking on concrete and other hard floors
3. 03Shoes that have changed, or lost their support and cushioning
4. 04Tight or stiff calves limiting how far the ankle bends
5. 05Reduced calf and foot muscle strength or endurance
6. 06A period off followed by a rapid return to training
7. 07An increase in body weight, including during pregnancy

4 of 8 · Assessment

Assessment & Diagnosis Process

The first appointment confirms the fascia is the pain source, works out why it became overloaded, and rules out the conditions that mimic it. Steve starts with the history, because the timeline usually gives away the cause.

If the picture does not fit, or a well executed plan has not produced the response we expect, we don't hesitate to refer for imaging or scans to make sure nothing is missed or further delayed.

Dr Steven Singh, Principal Podiatrist

01

Training load

Weekly kilometres or hours, sessions per week, recent jumps, surfaces, pace changes, hills, and how much standing your job adds on top.

02

Footwear

The shoes you train in and the shoes you work and live in, including age, mileage, wear pattern, midsole compression and how much they twist.

03

Physical examination

Ankle range with the knee straight and bent, first toe and midfoot mobility, calf raise capacity each side, and palpation to separate fascia from fat pad, bone and nerve.

04

Gait and running

How you contact the ground, how far the ankle bends over the foot, how the arch loads, plus cadence, stride and push off symmetry.

5 of 8 · Treatment

Treatment & Management Options

Treatment has two jobs running side by side: settle the current irritation, and raise the load the fascia can tolerate so the problem does not return when you go back to normal.

The part that changes outcomes is progressive loading. However, what we often see is people loading up the fascia without the tools they need to address the physiological changes in the fascia and the pain and symptoms that come with them.

1. 01Load modification so you can keep training in some form
2. 02Calf and plantar fascia strengthening, progressed over weeks
3. 03Ankle mobility work where range limits how you load the foot
4. 04Low dye taping or heel cups for short term relief
5. 05Footwear guidance for training, work and around the house
6. 06Manual therapy and calf release to support the loading program

6 of 8 · Recovery

What treatment involves and how long it takes

Plantar fasciitis does not need to take months to treat. The timeframes below are typical rather than guaranteed, and a case present for a year often behaves differently to one picked up early.

1. 1

   Your first visit

   History, load and footwear review, hands on examination and gait assessment, then a diagnosis, an initial exercise program, and often taping or a footwear change for immediate comfort.

2. 2

   One to four weeks

   The settling and building phase. If early treatment options fail, we typically refer you for a bulk billed ultrasound to get immediate feedback on the plantar fascia and why it's not healing.

3. 3

   Four weeks to three months

   Loading becomes heavier and more sport specific, and running or standing tolerance is rebuilt in steps. Occasional flares usually mean the dose moved a little fast.

4. 4

   Return to full sport

   Often six to eight weeks, longer for longstanding cases. Keep the strength work going past the point where pain settles, at your own intensity and level of activity.

7 of 8 · Prevention

Prevention & At-Home Advice

Prevention comes down to managing the size and speed of the load through the foot and keeping enough calf and foot strength to handle it. Distance, intensity, surfaces, footwear and hours on your feet are all doses, and stacking several changes in the same fortnight is what tips people over.

1. 01Increase volume and intensity gradually, changing one variable at a time
2. 02Keep calf and foot strengthening in your week once symptoms have gone
3. 03Wear supportive footwear for long periods of standing
4. 04Replace training shoes when the midsole has lost its cushioning

8 of 8 · Heel spurs and plantar fasciitis

Heel spurs and plantar fasciitis

A heel spur is a small outgrowth of bone at the underside of the heel bone, often picked up incidentally on an X ray taken for heel pain. Understandably, people assume the spur is what they are feeling.

The current view is that a spur is a response to long standing load rather than the source of pain, and finding one usually does not change your treatment.

• Heel spurs are common in people with no heel pain whatsoever
• Many painful plantar fasciitis cases show no spur on imaging
• A spur is usually a response to long term load
• Removing a spur is rarely the answer
• Treatment still targets fascia load and calf and foot capacity