Patients suffering with plantar fasciitis will almost always report significant and intense pain at the underside of the heel/s when rising from periods of rest. This intense pain usually reduces after a few minutes of activity. Research is yet to give us a definite reason as to why this first step pain occurs however there are several plausible theories. These include:
- Tissue shortening during periods of rest. The plantar fascia becomes tight and is not flexible enough to withstand stretching as your foot expands and splays on the ground. As a result, it tugs/pulls at the heel bone where it is attached. With activity, the tissue ‘warms up’ and becomes more flexible and the tugging on the heel bone reduces in intensity. This is the most plausible and widely-recognised of the causes.
- Dehydration to the soft tissue. Particularly valid for first step pain after long periods of rest, such as over-night sleep. This does not necessarily apply to those who experience first step pain after short periods of rest though.
- Neuromuscular causes. This considers the neural input to the soft tissue which perhaps isn’t functioning well.
Based on your symptoms and history, your Podiatrist can devise an appropriate treatment plan to address your mechanics, apply hands-on treatments (including shockwave therapy where indicated), implement a home exercise program and discuss any necessary changes in footwear and activity.
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