What can I do about plantar fasciitis?

There are a number of conditions that cause pain on the bottom of your heel. The most common cause is plantar fasciitis, which affects approximately 1 in 10 people.

The plantar fascia is a ligament-like structure that runs from the bottom of the heel to the ball of the foot, and helps to support the arch.

Plantar fasciitis is characterised by a sharp pain when first getting out of bed in the morning, which reduces with walking. However, the pain may return at the end of the day, and be just as painful as the morning pain.

Risk factors for plantar fasciitis include being overweight, increased time spent standing and a decreased ankle joint range of motion. These risk factors all place extra stress on the plantar heel, resulting in pain. Therefore, addressing these risks are a key part of successful management.

There are a variety of treatments that podiatrists use for plantar fasciitis, however there is no agreement on which treatment is the most effective.

Plantar fasciitis self-care treatments include:

• reducing weight (ideally a BMI below 30);

• reducing activity levels (e.g. amount of running) or time spent standing;

• wearing supportive cushioned footwear (e.g. runners);

• performing calf and plantar fascia stretches before standing after a period of rest.

If these treatments fail, there are a variety more complex treatment options, which can be provided by the podiatrists at Fitzroy Foot and Ankle Clinic. Two commonly provided treatments are foot orthotics and extracorporeal shockwave therapy. A number of clinical trials have demonstrated that these treatment options are effective for reducing plantar fasciitis. Given that a combination of treatments is likely to result in an optimal outcome, it is important to have a treatment plan tailored to you as an individual.

What are orthotics, and how do I know what to get?

Orthotics are a common treatment used for a variety of conditions. Broadly, there are two categories of orthotics provided by podiatrists, prefabricated and customised.

Prefabricated orthotics are mass produced and sized to fit a person's foot. There are a very wide variety of prefabricated orthotics that are manufactured, with some being better than others. For most people, prefabricated orthotics that are correctly fitted can be very effective to reduce pain and improve function (e.g. for short term conditions).

Customised orthotics are made by taking either a mould, an impression or a laser scan of a person's feet. This is then combined with a prescription by a podiatrist, that specifies what features the orthotic should have. Customised orthotics can be fabricated from a variety of materials, and have endless possibilities in terms of shape and function.

A podiatrist will be able to help you understand which type of orthotic will be best suited for you and the goals you want to achieve. One major consideration is cost, and there is a price difference between each option and the podiatrist can factor this in when discussing options with you.

How to pick the correct running shoes for you

A large amount of research has been conducted to understand out how to fit running shoes. Most of the research that has been conducted has concluded that patient comfort is one of the most important variables.

Below is a great video that summarises the history surrounding this research, and provides practical tips on how to select a running shoe for you. To summarise:

1. choose a shoe that is most comfortable to you - do not base your choice solely on what a store person suggests;

2. alternate the shoes you regularly wear to reduce your risk of injury;

3. injury is multifactorial and appropriate runners are one component of a comprehensive treatment program.