Plantar fasciitis is the most common cause of heel pain. It is often described as tightness of tissue that runs from your heel to your toes. This band can tighten and cause pain with increased standing, walking or running. It can also tighten due to excess weight gain or pregnancy. Most commonly, you will experience foot pain with the first few steps you take in the morning after getting out of bed.

Often times, when diagnosed with plantar fasciitis, patients are prescribed orthotics, anti-inflammatories and calf stretches. But after months of trying these treatments, you still have heel pain. Why?

As a physical therapist, although someone experiences pain in one area of the body, I have to think why and where? Why is this happening and where is the persistent heel pain coming from? When we walk, or run for that matter, a slew of events occur at our foot, ankle, knee, hip and trunk. It is often times a multitude of compensations that can occur throughout our body that can eventually break down in our foot. Some of these compensations can lead to or be caused by flat feet. Often times, individuals with plantar fasciitis also have flat feet.

When someone has flat feet, their arch collapses placing pressure not just on the fascia, but also on a nerve at the bottom of the heel as well.

The tibial nerve feeds the plantar fascia, along with other muscles in the lower leg, ankle and foot. In general, nerves do not like to be compressed or stretched. What happens when someone with flat feet walks? They compress the nerve under their heel as their heel strikes the ground, and then it is stretched when rolling over their toes. Branches of this nerve may also get compressed in other muscles in your leg or back.

If the tibial nerve is not addressed in treatment, your heel pain may not go away. Nerves require special hands on treatment techniques and exercises. Keep this in mind if you or someone you know is currently experiencing unrelenting heel pain that is not resolving with stretches, orthotics and anti-inflammatories.

If you have been diagnosed with plantar fasciitis, but continue to have pain, answer the questions below. If you answer YES to most or all of these questions, follow up with your local physical therapist.

1. Does the pain you experience resonate only in your heel?

2. Do you have a history of or current episode of low back pain?

3. Do you have flat feet?

4. Does your heel pain worsen when you stretch?

5. Do you experience burning or sharp pain in your heel?

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