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Heel pain is a common complaint, particularly at this time of year when people are wearing less supportive shoes, going barefoot at the beach, and starting a new exercise routine.
By the time I see them a lot of people have had their heel pain on-and-off for months or even years. The pain is often worst first thing in the morning – the first few steps out of bed. It then warms up in a few minutes and feels sore again when you first get up after sitting for a while through the day. The pain is often worse this morning if you’ve done more exercise yesterday. |
There’s usually a precipitating factor like an increase in training load (increased intensity of training – hills / sprints / increased number of sessions), change in shoes, or gain in weight. It’s quite common to see patients who are getting ready for an event, like doing a race or an overseas walking holiday, and have been exercising more in preparation.
The heel may be sore to start exercising, but often warms up so you can complete the session. Unfortunately the more exercise you do while it is sore, the worse it gets, until a point where it stays sore throughout the day and stops you exercising.
When we look at heel pain we start talking about the plantar fascia. The word “plantar” is used to describe the underneath surface of body parts. A “fascia” is a type of connective tissue that wraps groups of muscles, holding them in place. So the plantar fascia is on the bottom, or sole of the foot, between the foot muscles and the skin. It connects the heel to the toes, but is also tied in with the Achilles tendon and calf muscle. The arch of the foot is a shock absorber – it flattens as we put weight through it. The plantar fascia is stretched as part of that shock absorption mechanic.
Heel pain is a failure of the tissues that anchor on to the heel bone to cope with the stress of the load. Essentially they are overloaded and start to cause pain.
People use the term plantar fasciitis as a diagnosis of heel pain – “itis” meaning “inflammation” – so inflammation of the plantar fascia. Although heel pain may not always be inflammatory and there’s usually also some involvement of the other structures that attach on the heel bone, like the tendons of the foot muscles.
People are generally sore on the inside of the base of the heel. Some also have a sore strip along the arch of the foot. Some feel tight and/or burning.
The heel may be sore to start exercising, but often warms up so you can complete the session. Unfortunately the more exercise you do while it is sore, the worse it gets, until a point where it stays sore throughout the day and stops you exercising.
When we look at heel pain we start talking about the plantar fascia. The word “plantar” is used to describe the underneath surface of body parts. A “fascia” is a type of connective tissue that wraps groups of muscles, holding them in place. So the plantar fascia is on the bottom, or sole of the foot, between the foot muscles and the skin. It connects the heel to the toes, but is also tied in with the Achilles tendon and calf muscle. The arch of the foot is a shock absorber – it flattens as we put weight through it. The plantar fascia is stretched as part of that shock absorption mechanic.
Heel pain is a failure of the tissues that anchor on to the heel bone to cope with the stress of the load. Essentially they are overloaded and start to cause pain.
People use the term plantar fasciitis as a diagnosis of heel pain – “itis” meaning “inflammation” – so inflammation of the plantar fascia. Although heel pain may not always be inflammatory and there’s usually also some involvement of the other structures that attach on the heel bone, like the tendons of the foot muscles.
People are generally sore on the inside of the base of the heel. Some also have a sore strip along the arch of the foot. Some feel tight and/or burning.
Treatment
The two most important factors for treating heel pain are:
So we need to work out what aggravates the heel pain and do less of it. And we need to do some exercises to strengthen up the plantar fascia and foot muscles.
Adjunct treatments include:
- Decreasing the excessive load that has been aggravating the pain
- Strengthening up the load bearing capacity of the soft tissues
So we need to work out what aggravates the heel pain and do less of it. And we need to do some exercises to strengthen up the plantar fascia and foot muscles.
Adjunct treatments include:
- Reviewing footwear
- Staying in shoes at all times
- Orthotic prescription
- Low dye taping
- Strassburg Sock
- Ibuprofen
- Green tea
- Soft tissue techniques on the foot
- Dry needling
